标题：多囊卵巢综合征患者血清AMH、TNF-α、T、

      作者：DHEA-S的水平及临床意义    翟庆娜，刘芹兰，路瑞静，袁康凯，张修发，王丰深圳市宝安区妇幼保健院检验科，广东 深圳 518102

      卷次： 2020年31卷9期

      【摘要】 目的 探讨多囊卵巢综合征(PCOS)患者血清抗苗勒管激素(AMH)、肿瘤坏死因子-α (TNF-α)、睾酮(T)、硫酸脱氢表雄酮(DHEA-S)水平及临床意义，为患者的临床诊疗提供指导。方法 选择2017年8月至2019年9月在深圳市宝安区妇幼保健院治疗的 220例PCOS患者为观察组，并选择我院同期体检健康人群 180例作为对照组。检测两组受检者的血清AMH、TNF-α、T、DHEA-S表达水平，计算各指标诊断PCOS的曲线下面积(AUC)及 95%置信区间 (95%CI)，分析其诊断价值。结果 观察组患者的 AMH、TNF-α、T及 DHEA-S水平分别为(8.74±4.27) pg/mL、(271.56±130.86) pg/mL、(0.72±0.26) nmoI/L、(8.17±3.23) μg/dL、(3.25±1.54) pg/mL，明显高于对照组的(5.46±2.19) pg/mL、(212.64±99.25) pg/mL、(0.46±0.18) nmoI/L、(6.69±2.78) μg/dL、(1.42±0.63) pg/mL，差异均有统计学意义(P<0.05)；血清AMH诊断 PCOS的AUC为 0.754，95%CI为 0.705~0.802；血清 TNF-α诊断 PCOS的AUC为 0.629，95%CI为 0.575~0.683；血清T诊断PCOS的AUC为 0.815，95%CI为 0.774~0.856；血清DHEA-S诊断PCOS的 AUC为 0.654，95%CI为 0.601~0.70；AMH+TNF-α+T+DHEA-S诊断 PCOS的 AUC为 0.892，95%CI为0.861~0.924；AMH+TNF-α+T+DHEA-S联合检测诊断 PCOS的AUC明显高于单独检测，差异有统计学意义(P<0.05)；AMH+TNF-α+T+DHEA-S联合检测的特异度及准确度均明显高于单独检测，差异均有统计学意义(P<0.05)。结论 PCOS血清AMH、TNF-α、T、DHEA-S水平均明显升高，四项指标联合检测对PCOS有较高的诊断价值，且各指标的变化有助于指导临床诊疗。
      【关键词】 多囊卵巢综合征；抗苗勒管激素；肿瘤坏死因子-α；睾酮；硫酸脱氢表雄酮
      【中图分类号】 R442.8 【文献标识码】 A 【文章编号】 1003—6350（2020）09—1100—03

Detection of serum AMH, TNF-alpha, T, and DHEA-S in patients with polycystic ovary syndrome and itsclinical significance.
ZHAI Qing-na, LIU Qin-lan, LU Rui-jing, YUAN Kang-kai, ZHANG Xiu-fa, WANG Feng.Department of Clinical Laboratory, Maternal and Child Health Hospital of Bao'an District, Shenzhen 518102, Guangdong,CHINA
【Abstract】 Objective To explore the levels of anti-Müllerian hormone (AMH), tumour necrosis factor-α(TNF-alpha), testosterone (T) and dehydroepiandrosterone sulfate (DHEA-S) in patients with polycystic ovary syndromeand its clinical significance. Methods A total of 220 patients with polycystic ovary syndrome (PCOS), who receivedthe treatment at the Maternal and Child Health Hospital of Bao'an District, Shenzhen from August 2017 to September2019, were enrolled into the observation group, and 180 healthy people in at the Maternal and Child Health Hospital ofBao'an District, Shenzhen were selected as the control group. The serum levels of AMH, TNF-α, T, and DHEA-S were de-tected in two groups of subjects, and the area under the curve (AUC) and 95% confidence interval (95% CI) for the diagno-sis of PCOS were calculated for each indicator, and their diagnostic value was analyzed. Results The levels of AMH,TNF-α, T and DHEA-S in the observation group were (8.74±4.27) pg/mL, (271.56±130.86) pg/mL, (0.72±0.26) nmol/L,(8.17±3.23) μg/dL, (3.25±1.54) pg/mL, respectively, which were significant higher than corresponding (5.46±2.19) pg/mL,(212.64±99.25) pg/mL, (0.46±0.18) nmol/L, (6.69±2.78) μg/dL, (1.42±0.63) pg/mL in the control group (all P<0.05).The AUC of serum AMH in the diagnosis of PCOS was 0.754, and 95% CI was 0.705-0.802; the AUC of serumTNF-α was 0.629, 95% CI was 0.575-0.683; the AUC of serum T was 0.815, 95% CI was 0.774-0.856; the AUC ofDHEA-S was 0.654 and 95% CI was 0.601-0.70; the AUC of AMH+TNF-α+T+DHEA-S was 0.892 and 95% CI was0.861-0.924; the AUC of AMH+TNF-α+T+DHEA-S was significantly higher than that of single test (P<0.05); thespecificity and accuracy of AMH + TNF-α+ T + DHEA-S were significantly higher than that of single test (P<0.05).Conclusion The levels of serum AMH, TNF-α, T, and DHEA-S in PCOS are significantly increased. The combined de-tection of the four indicators has higher diagnostic value for PCOS, and the changes in each indicator were helpful toguide clinical diagnosis and treatment.
      【Key words】 Polycystic ovary syndrome (PCOS); Anti-Müllerian hormone (AMH); Tumor necrosis factor-alpha(TNF-alpha); Testosterone (T); Dehydroepiandrosterone sulfate (DHEA-S)