抗缪勒管激素诊断多囊卵巢综合征的年龄特异性阈值探讨及应用

Exploration and application of age-specific cut-off values for anti-Müllerian hormone in the diagnosis of polycystic ovary syndrome

目的 探讨抗缪勒管激素(AMH)诊断多囊卵巢综合征(PCOS)的年龄特异性阈值及其诊断效能。方法 收集该院2 187例14~40岁的月经紊乱的患者样本,并采用免疫荧光方法测定血清AMH水平,符合鹿特丹标准患者为PCOS组,反之为对照组。利用广义加性模型(GAMs)和受试者工作特征(ROC)曲线下面积(AUC)确立AMH的年龄区间和对应的阈值。评估各年龄区间AMH诊断PCOS的效能,并与试剂厂商提供的阈值进行比较。结果 基于GAMs模型,AMH预测PCOS的最佳年龄截断值分别为21、28和35岁。在14~<21岁、21~<28岁、28~<35岁和35~40岁年龄组中,AMH诊断阈值分别为8.28、8.02、6.70、3.96 ng/mL;AUC分别为0.97(95%CI:0.93~0.99)、0.97(95%CI:0.95~0.98)、0.98(95%CI:0.95~0.98)、0.99(95%CI:0.98~0.99);灵敏度分别为0.87、0.87、0.91、1.00;特异度分别为0.94、0.93、0.90、0.93。在各年龄组中,PCOS组的AMH水平均高于对照组,差异具有统计学意义(P<0.001)。结论 应用AMH的年龄特异性阈值,可以更好地评估AMH在区分所有年龄段PCOS患者中的价值。

Objective To investigate the age-specific cut-off values and diagnostic efficacy of anti-Muller hormone(AMH)in the diagnosis of polycystic ovary syndrome(PCOS).Methods The Serum AMH levels were measured by immunofluorescence assay in 2187 patients with menstrual disorders aged 14-40 years in the hospital.Patients who met the Rotterdam criteria were classified as the PCOS group,while those who did not were classified as the control group.The generalized additive model(GAMs)and the area under the receiver operating characteristic(ROC)curve(AUC)were used to establish the age interval and the corresponding cut-off values of AMH.The efficacy of AMH in diagnosing PCOS in each age interval was evaluated and compared with the cut-off values provided by the reagent manufacturer.Results Based on GAMs model,the age cut-off values for AMH in predicting PCOS were 21,28,and 35 years old,respectively.The cut-off values for the prediction of PCOS in the age categories of 14-<20,20-<28,28-<35,and 35-40 years were 8.28,8.02,6.70,3.96 ng/mL.The AUC was 0.97(95%CI:0.93-0.99),0.97(95%CI:0.95-0.98),0.98(95%CI:0.95-0.98),and 0.99(95%CI:0.98-0.99),the sensitivity was 0.87,0.87,0.91,and 1.00,and the specificity was 0.94,0.93,0.90,and 0.93,respectively.In all age groups,AMH level in PCOS group was higher than that in control group,and the difference was statistically significant(P<0.001).Conclusion Application of age-specific cut-off values of AMH could elegantly assess the value of AMH in discriminating PCOS patients in all age categories.