Exploration Of The Diagnostic Value Of Anti-mullerian Hormone In PCOS And Its Correlation With Female Sex Hormone Levels

Background and purpose:Polycystic ovary syndrome（PCOS）is a very common endocrine metabolic disorder disease,its clinical characteristics are ovulation disorder,androonism and ovarian polycystic changes.PCOS can lead to abnormal uterine bleeding（including irregular vaginal bleeding,amenorrhea,and even cause endometrial hyperplasia,etc.）,hairy and acne,obesity,acaniganthosis,ovulation of childbearing age（infertility）,abortion,pregnancy complications（including pregnancy diabetes,hypertension,etc.）and cesarean section,menopausal women of cardiovascular disease,obstructive sleep apnea syndrome,dyslipidemia,diabetes,endometrial cancer,etc.There are also mood disorders such as anxiety and depressive symptoms and impaired self-esteem.Therefore,the early identification and diagnosis of PCOS is particularly important.The early diagnosis of patients and individualized comprehensive treatment and management as early as possible will greatly reduce the impact of PCOS on patients’ health and psychology.However,the current diagnostic criteria of PCOS are based on the opinions of experts,and the international diagnostic criteria of PCOS are not completely unified.Therefore,it is very important to find a clear diagnostic criteria of PCOS.In recent years,related studies have found significantly higher circulating AMH levels in PCOS patients than women without ovulation disorder,and a strong correlation between AMH serum levels and follicle count on ultrasound examination,so AMH is considered a surrogate marker of ovulation dysfunction in PCOS patients,and the diagnostic value of AMH in PCOS is constantly recognized.However,the results in the current literature are not uniform,so it is important to explore the diagnostic value of AMH in PCOS and to investigate the association between AMH and sex hormone levels in women.Through retrospective analysis,the clinical data were collected,sorted,analyzed and summarized to obtain the diagnostic value of AMH in PCOS and the correlation between AMH and female sex hormone levels,so as to realize the early identification of PCOS and improve the prognosis.Data and methods:The data of PCOS patients attending the gynecological outpatient department from January 2019 to January 2021 in our hospital were retrospectively analyzed.According to the inclusion and exclusion criteria,a total of 142 eligible patients with polycystic ovary syndrome were taken as the experimental group,and 114 patients with PCOS and perfect endocrine data in the same period were used as the control group.SPSS 26.0 statistical software was used to analyze study subject data.Measurement data with normal distribution were expressed by mean ± standard deviation（（?）± s）,and t-test was used for continuity variables between groups.One-way analysis of variance was used to determine the difference in hormone levels between age groups（21-30,31-40 years）.Correlation analysis was used to study the correlation between AMH and other indicators in the PCOS group,and the Pearson correlation coefficient was used to represent the strength of the correlation between each other.The critical value of the AMH level as the base predictor of the PCOS diagnostic predictor was analyzed using the receiver operating feature curve（ROC curve）.The predictive accuracy of the logistic model was evaluated by calculating the area under the receiver operating feature curve（ROC-AUC）.Fruit:（1）142 PCOS patients were aged from 21 to 39 years,with mean age of 30.99±3.30 years,menarche of 11 to 18 years,mean age at menarche of 13.67±1.44 years,and mean duration of 6.04 days.The 114 Non-PCOS patients ranged from 21 to 40 years,with mean age of 31.41±3.68,menarche 11 to 18,mean age at menarche 13.98 ± 1.27,and 5.88 days.There were no significant difference in age,age at menarche or menstruation in the two groups,P> 0.05.（2）142 PCOS patients had the longest menstrual cycle of 730 days and the shortest of15 days,with an average of 32.50 days.The 114 non-PCOS patients had a maximum menstrual cycle of 90 days and a minimum of 20 days,with a mean of 29.39 days.The menstrual cycle was significantly longer than that in the non-PCOS group,with P <0.05.（3）142 BMI values of PCOS patients were 17.19~36.65kg/ m~2 and the mean was24.63kg/ m~2.BMI value interval 14.88~34.20kg/ m~2 in 114 Non-PCOS patients with mean22.47kg/m~2.The mean BMI was significantly higher in PCOS patients and higher than in the Non-PCOS group,P <0.05.（4）142 Max AMH in PCOS patients was 23.35ng/ml,with a minimum value of 1.47ng/ml and a mean value of 8.86 ng/ml.The maximum AMH of 114 PCOS patients was21.87ng/ml,with a minimum of 0.09 ng/ml and a mean of 4.69 ng/ml.The mean value was significantly higher in the PCOS group and higher than in the Non-PCOS group,P <0.05.（5）142 The maximum LH in PCOS patients was 26.24 m IU/ml,the minimum was2.02 m IU / ml,and the mean was 8.77 m IU / ml.The maximum LH in 114 Non-PCOS patients was 13.94 m IU/ml,with a minimum of 1.29 m IU / ml and a mean of 5.78 m IU / ml.The mean value was significantly higher in the PCOS group and higher than in the Non-PCOS group,P <0.05.（6）The mean LH / FSH of the 142 PCOS patients was 1.50.The mean LH / FSH of the114 Non-PCOS patients was 0.96,and the mean was significantly higher in the PCOS group than in the Non-PCOS group,with P <0.05.（7）142 PCOS patients and 114 Non-PCOS patients in FSH,E2 and P,P> 0.05（8）Samples of different age groups（21 to 30,31 to 40 years）in the Non-PCOS group showed consistency for AMH,FSH,LH,E2,T,P,PRL and LH / FSH,P> 0.05.（9）Samples of different ages（21 to 30,31 to 40 years）in the PCOS group showed consistency for AMH,FSH,LH,E2,T,P,PRL,and LH / FSH,with P> 0.05.（10）There was a significant positive correlation between AMH and LH,LH / FSH,and basal sinus follicle number AFC,with P <0.05.（11）There was no association between AMH and age,FSH,E2,T,P,and PRL,with P>0.05.（12）The area under the ROC curve of AMH was 0.787,which was significantly greater than the random diagnostic probability of 0.5,indicating that AMH was statistically significant for diagnosing PCOS.（13）Using sensitivity and 1-specificity,we can find the yoden index of 0.47,the corresponding sensitivity and specificity of 0.768 and 0.702,respectively,and the corresponding AMH cut-off value of 5.14 ng/ml,i.e.,AMH≥5.14ng/ml can be diagnosed as the PCOS group.Conclusion:（1）The study found that serum AMH levels in PCOS patients were significantly higher than those in normal women,and that serum AMH levels can reflect the degree of impaired ovulation disorder in PCOS patients,indicating that AMH has diagnostic value.Through the analysis,we can conclude that when the serum AMH level is 5.14 ng/ml,the diagnosis of PCOS is more preferred clinically.（2）There was a significant positive relationship between serum anti-muslerian hormone level and LH value and LH / FSH ratio.With the increase of serum LH level,AMH secreted by ovarian granulosa cells in PCOS patients increased accordingly;AMH inhibited FSH and eventually led to LH,FSH and LH / FSH ratio in PCOS patients.（3）Serum anti-mullerian hormone level and increased LH,LH/FSH ratio has good diagnostic value in the diagnosis of PCOS,and there are close links between these hormone level change characteristics,therefore,the clinical work can be used in patients,will effectively improve the diagnostic accuracy of patients.