多囊卵巢综合征患者血清FSH、AMH及ES的表达情况及其对疾病的诊断和预后意义

Expression of serum FSH,AMH and ES in patients with polycystic ovary syndrome and its significance in diagnosis and prognosis

目的探讨多囊卵巢综合征(PCOS)患者血清促卵泡生成素(FSH)、抗缪勒管激素(AMH)及内皮抑制素(ES)的表达情况及其对疾病的诊断和预后意义。方法回顾性选取2019年5月至2022年5月阜阳市妇女儿童医院收治的60例PCOS患者作为研究对象,将其作为观察组;另取同期来阜阳市妇女儿童医院体检的健康育龄期女性60名作为对照组。比较两组患者FSH、AMH及ES表达水平,应用受试者工作特征(ROC)曲线分析FSH、AMH、ES以及三者联合对PCOS的诊断效能。治疗3个月后,对所有患者进行跟踪随访,依照超声诊断判断患者预后情况,将预后良好的42例患者分为预后良好组,将预后不良的18例患者分为预后不良组,比较两组患者临床一般情况与血清FSH、AMH及ES的表达水平,应用Spearman相关分析分析血清FSH、AMH及ES与PCOS预后的相关性,并分析FSH、AMH及ES对PCOS的预后预测价值。结果观察组患者血清FSH及ES水平为(6.25±2.21)mIU/mL、(26.26±6.78)ng/mL,明显低于对照组[(8.38±2.15)mIU/mL、(52.24±13.52)ng/mL],AMH水平为(12.25±3.25)ng/mL,明显高于对照组[(2.24±0.37)ng/mL],差异均有统计学意义(P<0.05)。ROC曲线分析显示:曲线下面积从低到高依次为AMH(0.631)、FSH(0.667)、ES(0.671)、联合诊断(0.852)。AMH诊断敏感度为51.87%,特异度为55.47%;FSH诊断敏感度为48.03%,特异度为67.53%;ES诊断敏感度为62.58%,特异度为86.32%;联合诊断诊断敏感度为87.36%,特异度为93.56%。血清FSH、AMH及ES的联合诊断的敏感度与特异度明显高于血清FSH、AMH及ES单一诊断。预预后良好组与预后不良组患者年龄、卵泡数、卵巢体积、黄体生成素、雌二醇比较差异无统计学意义(P>0.05),预后良好组体重指数、血清AMH低于预后不良组,血清FSH、ES高于预后不良组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示:FSH、ES与PCOS预后呈正相关,AMH与其呈负相关(P<0.05);Logistic回归分析结果显示:FSH、AMH为PCOS的预后独立影响因素(P<0.05)。结论FSH、AMH及ES联合对PCOS诊断敏感度与特异度较高,因此临床可考虑应用三者联合对PCOS进行诊断。另外,AMH对于多囊卵巢综合的预后情况具有独立预测价值,也可应用血清AMH水平来判断患者预后情况。

Objective To investigate the expression of serum follicle stimulating hormone(FSH),anti Mullerian hormone(AMH)and endostatin(ES)in patients with polycystic ovary syndrome(PCOS)and their significance in diagnosis and prognosis.Methods Sixty patients with PCOS admitted to Fuyang Women’s and Children’s Hospital from May 2019 to May 2022 were selected as the research objects,and they were divided into the observation group.Sixty healthy women of childbearing age who came to Fuyang Women’s and Children’s Hospital for physical examination in the same period were selected as the control group to compare the expression levels of FSH,AMH and es in the two groups.The diagnostic efficacy of FSH,AMH,ES and their combination for PCOS was analyzed using the receiver operating(ROC)curve.All patients were followed up for 3 months.According to the ultrasound diagnosis,the prognosis of patients was judged.42 patients with good prognosis were divided into good prognosis group and 18 patients with poor prognosis were divided into poor prognosis group.The clinical general conditions of patients in the two groups were compared with the expression levels of serum FSH,AMH and es.Spearman correlation analysis was used to analyze the correlation between serum FSH,AMH and ES and the prognosis of PCOS,and to analyze the relationship between FSH The prognostic value of AMH and es in PCOS.Results The levels of serum FSH and es in the observation group were(6.25±2.21)mIU/mL,(26.26±6.78)ng/mL,which were significantly lower than those in the control group[(8.38±2.15)mIU/mL,(52.24±13.52)ng/mL],and the levels of AMH were(12.25±3.25)ng/mL,which were significantly higher than those in the control group[(2.24±0.37)ng/mL],the differences were statistically significant(P<0.05).ROC curve analysis showed that the area under the curve(AUC)from low to high was AMH(0.631),FSH(0.667),ES(0.671),and combined diagnosis(0.852).The diagnostic sensitivity and specificity of AMH were 51.87%and 55.47%respectively.The diagnostic sensitivity and specificity of FSH were 48.03%and 67.53%,respectively.The sensitivity and specificity of ES were 62.58%and 86.32%respectively.The sensitivity and specificity of combined diagnosis were 87.36%and 93.56%,respectively.The sensitivity and specificity of combined diagnosis of serum FSH,AMH and ES were significantly higher than that of single diagnosis of serum FSH,AMH and ES.There was no significant difference in age,follicle number,ovarian volume,LH and E2 between the good prognosis group and the poor prognosis group(P>0.05).Body mass indexand serum AMH in the good prognosis group were lower than those in the poor prognosis group,and serum FSH and ES were higher than those in the poor prognosis group(P<0.05).Spearman correlation analysis showed that FSH,ES were positively correlated with the prognosis of PCOS,and AMH was negatively correlated with it(P<0.05).Logistic regression analysis showed that FSH and AMH were independent prognostic factors of PCOS(P<0.05).Conclusion The combination of FSH,AMH and ES has high sensitivity and specificity in the diagnosis of PCOS.Therefore,the combination of FSH,AMH and ES can be considered for the diagnosis of PCOS.In addition,AMH has independent predictive value for the prognosis of PCOS,and serum AMH level can also be used to judge the prognosis of patients.