卵巢窦卵泡数对不同年龄段多囊卵巢综合征患者的临床诊断价值

Clinical diagnostic value of antral follicle count for PCOS patients with different ages

目的探讨窦卵泡数对不同年龄段PCOS患者的临床诊断价值,并确定最佳的诊断截点值。方法回顾性分析2015年10月至2018年10月接受IVF/ICSI治疗的患者资料,将78例PCOS患者设为PCOS组,同期114例非PCOS患者设为非PCOS组。根据年龄将两组患者进一步分成3个亚组:<30岁组、30~35岁组和≥36岁组。对所有患者行阴道超声计数卵巢窦卵泡数,并比较PCOS组和非PCOS组窦卵泡数的差异;利用ROC曲线比较窦卵泡数诊断不同年龄段PCOS的诊断效率,并根据Youden指数确定最佳的诊断截点值。结果各年龄段PCOS患者的窦卵泡数均显著多于非PCOS患者(P<0.01);PCOS患者和非PCOS患者的窦卵泡数都随年龄增长而递减,≥36岁组的窦卵泡数[PCOS组为(10.50±3.45)个,非PCOS组为(6.13±3.06)个]均显著少于同类患者<30岁组[PCOS组为(14.63±4.12)个,非PCOS组为(9.54±2.77)个]或30~35岁组[PCOS组为(13.58±2.96)个,非PCOS组为(9.45±2.65)个],(P均<0.05);同类患者<30岁组和30~35岁组窦卵泡数比较,无显著差异(P>0.05);窦卵泡数诊断PCOS的ROC曲线下面积(AUC)为0.824,具体到3个亚组分别为<30岁组0.848、30~35岁组0.849和≥36岁组0.828。Youden指数确定的窦卵泡数在3个年龄段最佳的诊断截点值分别为<30岁组13个、30~35岁组12个和≥36岁组10个。结论窦卵泡数作为PCOS的诊断指标,准确可靠,对不同年龄段育龄期PCOS患者均具有很好的诊断价值,其诊断截点值随患者年龄增长而减小。

Objective:To investigate the clinical diagnostic value of antral follicle count for polycystic ovary syndrome(PCOS)patients in different age,and determine the optimal diagnostic cut-off point.Methods:The data of 78 PCOS patients(experimental group)and 114 Non-PCOS patients(control group)who received IVF/ICSI treatment were respectively analyzed.Each group was further divided into three subgroups according to their ages:<30 years,30-35 years and≥36 years.Transvaginal ultrasound examination was performed to count the number of antral follicles in all patients and the differences between the experimental group and the control group were compared.ROC curve was used to compare the diagnostic efficiency of antral follicle count for PCOS in different age groups,and the optimal diagnostic cut-off point was determined according to Youden index.Results:The number of antral follicles in PCOS patients was significantly higher than that in Non-PCOS patients(P<0.01).The number of antral follicles decreased with age in both PCOS patients and Non-PCOS patients.The number of antral follicles in patients≥36 years old[PCOS group(10.50±3.45),Non-PCOS group(6.13±3.06)]was significantly less than that in patients<30 years old[PCOS group(14.63±4.12),Non-PCOS group(9.54±2.77)]or 30-35 years old group[PCOS group(13.58±2.96),Non-PCOS group(9.45±2.65)],(all P<0.05).There was no significant difference in the number of antral follicles in similar patients(PCOS or Non-PCOS group)between the group aged less than 30 years and the group aged 30-35 years(P>0.05).The area under the ROC curve(AUC)for PCOS diagnosis by antral follicle count was 0.824,and that for each age subgroup was 0.848,0.849 and 0.828,respectively.The optimal cut-off point of the number of antral follicles determined by Youden index was 13 for the<30 age group,12 for the 30-35 age group and 10 for the≥36 age group,respectively.Conclusions:Antral follicle count is an accurate and reliable diagnostic index for PCOS,and it has a good diagnostic value for PCOS patients in different age.Its diagnostic cut-off point decreases with age.