抗苗勒管激素在多囊卵巢综合征及下丘脑性闭经中的变化分析

Variations in anti-muilerian hormone in polycystic ovary syndrome and hypothalamic amenorrhea

目的探讨抗苗勒管激素（AMH）在多囊卵巢综合萱LE（PCOS）及下匠脑性闭经患者中的变化分析及其对PCOS的诊断价值。方法收集14例PCOS患者（PCOS组）及10例下丘脑性闭经患者（下丘脑性闭经组）的病例资料，记录其年龄、血清睾酮（TES）、游离睾酮（F—TEST）、雄烯二酮（AND）等性激素水平；同时收集健康体检者25例作为对照组，检验其血清AMH浓度并对3组问各项指标进行比较。结果PCOS组的AMH浓度均明显高于下匠脑性闭经组及对照组（P〈0．001），下丘脑性闭经组与对照组比较差异无统计学意义（P=0．763）．Pearson分析结果显示，PCOS组患者的AMH与年龄、TES、F—TEST、AND等指标均无明显相关性（P〉0．05），下匠脑性闭经组患者的AMH仅与FSH呈负相关（r=-0．653，P=0．041）。此外，通过受试者工作特征（ROC）曲线得出经AMH区分PCOS与下匠脑性闭经的最佳界值为7．02ng／ml．准确度79．2％，敏感度64．3％、特异度100．0％（中等诊断效能）；PCOS组与对照组的AMH最伟界值为7．225ng／ml，准确度84．6％，敏感度64．3％、特异度96．6％（中等诊断效能）。未能找到区分下匠脑性闭经与对照组的血清AMH界值（P=0．596）。结论AMH在PCOS患者中旱较高浓度，且与其他性激素无明显相关，可作为PCOS的良好诊断指标，而在下丘脑性闭经组则未见该趋势。

Objective To investigate the variations of anti-Mullerian hormone（AMH） in patients with polycystic ovary syndrome（PCOS） and hypothalamic amenorrhea and its diagnostic value tbr PCOS. Methods Fourteen eligible patients diagnosed with PCOS and 10 patients with hypothalamic amenorrhea were recruited and their age, serum testosterone （TES） , free testosterone （F-TEST） and androstenedione （AND） and other sex hormones were recorded. At the same time,25 normal individuals were collected as the control group and their AMH were measured. Results The serum AMH concentration in PCOS group was obviously higher than those of hypothalamic amenorrhea group and control group （ P 〈 0.001 ） while no difference was found between hypothalamic amenon＇hea group and control group （ P = 0. 763 ）. Pearson analysis showed no significant correlation in PCOS group between serum AMH and age, TES, F-TEST, AND and other sex hormones （ P 〉 0.05 ）, while serum AMH in hypothalamic amenorrhea group had a negative correlation with FSH（ r = - 0. 653,P = 0. 041 ）. In addition, the receiver operating characteristic （ROC） curve provided the optimal cut-off point of serum AMH concentration between PCOS and hypothalamic amenorrhea, which was 7. 020 ng/ml with the diagnosis accuracy of 79.2% , the sensitivity of 79.2% and specificity was 100.0% （medium diagnostic efficiency）. The optimal cut-off point of serum AMH concentration between PCOS and control group was 7. 225 ng/ml with the diagnosis accuracy of 84.6% ,the sensitivity of 64.3% and the speeificity of 96.6% （ medium diagnostic efficiency ）. It was not available to find out the optimal cut-off point of serum AMH concentration between hypothalamie amenorrhea and the control group（P =0.596）. Conclusion The serum AMH concentration is higher in PCOS patients which can be used as a good index to diagnose PCOS, and its conelation with other sex hormone is not obvious. No similar trend is observed in the hypothalamic amenorrhea group.