The Diagnostic Value Of Serum Anti-müllerian Hormone Combined With Sex Hormones For Polycystic Ovary Syndrome

Objective To investigate the diagnostic value of serum anti-Müllerian hormone combined with sex hormones for polycystic ovary syndrome(PCOS).Methods The serum levels of anti-Müllerian hormone(AMH),testosterone(T),luteinizing hormone(LH),follicle-stimulating hormone(FSH)and the estradiol(E2)were measured by using electrochemiluminescence method in 82 patients with PCOS and age matched 60 controls.Comparisons between groups were performed using the Mann-Whitney U test.The correlations of serum AMH levels with ages and sex hormones levels were analyzed separately in the PCOS and control groups by spearman correlation analysis.The diagnostic values of the indicators and their combination for PCOS were evaluated by receiver operating characteristic curve,sensitivity and specificity.The area under the receiver operating characteristic curve was compared by the z-score test.The sensitivity and specificity were compared by chi-square test.The changes of serum AMH levels were studied in 159 healthy women.Multivariate comparisons were performed using the nonparamertric Kruskal-Wallis H test.Results(1)The levels of serum AMH,T,LH and LH/FSH ratio in patients with PCOS were obviously higher than those in controls(8.71ng/mL vs 3.87ng/mL,1.39nmol/L vs 0.88 nmol/L,12.72IU/L vs 6.44IU/L,2.17 vs 1.17,P < 0.01).There was no significant difference in age,the levels of FSH and E2(26 years vs 27 years,5.86IU/L vs 6.11IU/L,135.70pmol/L vs 138.65pmol/L,P > 0.05).(2)Correlation analysis showed that serum AMH levels were positively correlated with ones of T,LH and LH/FSH ratio(r=0.258,0.241 and 0.290,respectively,P < 0.05),but not correlated with age in PCOS group(r=-0.178,P > 0.05).In the control group,AMH levels had no correlations with ones of T,LH and LH/FSH ratio(r=0.025,0.104,0.111,P > 0.05),while negatively correlated with age(r=-0.307,P < 0.05).(3)The the areas under the receiver operating characteristic curves of each indicators for diagnosis of PCOS were compared,AMH(0.880)was higher that of T,LH or LH/FSH ratio itself(0.778,0.760,0.778,P < 0.05),but no significant differences were found comparing with AMH and the combination of AMH+T,AMH+LH,AMH+LH/FSH or AMH+T+LH(0.892,0.897,0.898,0.902,P > 0.05).The sensitivity of AMH(80.5%)for diagnosis of PCOS was higher than that of LH(62.2%)and LH/FSH ratio(54.9%,P < 0.05).The sensitivity of AMH(80.5%)increased when combined with T(89.0%),LH(87.8%)or T+LH(95.10%,P < 0.05).While the specificities were not shown statistical significance between any two indicators,including their combinations(P > 0.05).(4)Serum AMH levels were significant different among the different age groups in healthy women(H=98.7,P < 0.01),and negatively correlated with ages(r=-0.812,P < 0.01).(5)When examining the population by age groups,the cutoff value of AMH for diagnosis of PCOS decreased with age.Conclusion(1)Serum AMH levels were significantly elevated in patients with PCOS,and had certain diagnostic value for PCOS.(2)Abnormal increase of serum AMH levels in patients with PCOS were related to the disorder of sex hormone synthesis.(3)The sensitivity of AMH for diagnosis of PCOS was significantly higher than that of LH and LH/FSH ratio,and the sensitivity could be further improved by the combination with T or / and LH without reducing the specificity.(4)Age-stratified cut-off values of AMH were better for accurate diagnosis of PCOS.