血清抗苗勒管激素联合25-羟基维生素D对多囊卵巢综合征的诊断效能分析

Efficacy analysis of serum anti-Mullerian hormone combined with 25-hydroxyvitamin D in the early diagnosis of polycystic ovary syndrome

目的分析血清抗苗勒管激素(AMH)联合25-羟基维生素D[25(OH)VD]对多囊卵巢综合征(PCOS)的诊断效能。方法选取2018年5月至2019年5月武汉市优抚医院诊治的64例PCOS患者作为研究对象。将这64例患者设为观察组,另选同期且年龄匹配的64例输卵管性不孕患者作为对照组。检测并比较两组患者血清性激素、糖代谢指标、AMH和25(OH)VD水平,分别进行多因素和相关性分析,使用受试者工作特征曲线(ROC)下面积(AUC)量化25(OH)VD和AMH对PCOS的诊断效能,获取最佳诊断截值。结果观察组患者血清黄体生成素(LH)、睾酮(T)、空腹胰岛素(INS)、AMH和25(OH)VD水平均明显高于对照组患者,胰岛素抵抗指数(HOMA-IR)明显大于对照组患者,差异均具有统计学意义(均P<0.05);多因素分析显示,LH、T、INS、HOMA-IR、AMH和25(OH)VD均是预测多囊卵巢综合征的独立危险因素,差异均具有统计学意义(均P<0.05);多囊卵巢综合征患者血清LH、T、INS、HOMA-IR与AMH均呈正相关,差异均具有统计学意义(均P<0.05),与25(OH)VD均呈负相关,差异具有统计学意义(P<0.05);ROC分析显示,AMH和25(OH)VD诊断PCOS的最佳截值分别为9.15ng/mL、26.45nmol/L,联合诊断的灵敏度和特异度均较单一指标提高,AUC为0.915明显大于AMH的0.675和25(OH)VD的0.695,差异均具有统计学意义(均P<0.05)。结论PCOS患者血清AMH水平升高和25(OH)VD水平降低均与内分泌及代谢紊乱有关,两者联合诊断的效能较高,在临床诊治中应予以重视。

Objective To analyze the early diagnostic efficacy of serum anti-Mullerian hormone(AMH)combined with 25-hydroxyvitamin D[25(OH)VD]for polycystic ovary syndrome(PCOS).Methods 64 patients with PCOS in Wuhan Youfu hospital from May 2018 to May 2019 were selected as the observation group.Another 64 patients with tubal infertility who were matched with age during the same period were selected as the control group.The serum sex hormones,glucose metabolism index,AMH,25(OH)VD levels were detected and compared.Multivariate and correlation analysis were performed and the area under the receiver operating characteristic(ROC)curve(AUC)was used to quantify the diagnostic efficacy of 25(OH)VD and AMH for PCOS to obtain the best diagnostic cutoff.Results Serum luteingenin(LH),testosterone(T),fasting insulin(INS),AMH,25(OH)VD levels in the observation group were significantly higher than those in the control group,and insulin resistance index(HOMA-IR)was significantly higher than that in the control group,with statistically significant differences(all P<0.05).Multivariate analysis showed that LH,T,INS,HOMA-IR,AMH and 25(OH)VD were all independent risk factors for predicting PCOS,with statistically significant differences(all P<0.05).Serum LH,T,INS and HOMA-IR of patients with PCOS were positively correlated with AMH,and negatively correlated with 25(OH)VD,all with statistically significant differences(all P<0.05).ROC analysis showed that the optimal cut-off values of AMH and 25(OH)VD for the diagnosis of PCOS were 9.15ng/mL and 26.45nmol/L;the sensitivity and specificity of combined diagnosis were improved compared with the single index,and the AUC was 0.915,which was significantly greater than 0.675 of AMH and 0.695 of 25(OH)VD,with statistically significant differences(all P<0.05).Conclusions The elevated serum AMH level and the decrease of 25(OH)VD level in patients with PCOS are related to endocrine and metabolic disorders,and the combined diagnosis is more effective,which should be paid attention to in clinical diagnosis and treatment.