血清AMH、adropin和DHEAS表达与PCOS患者发病的相关性及对疗效的预测价值分析

The correlation between serum AMH, adropin and DHEAS expression with the onset of PCOS patients and its predictive value for treatment efficacy analysis

摘要

目的 探讨血清抗缪勒管激素(AMH)、adropin(AD)和硫酸脱氢表雄酮(DHEAS)表达与多囊卵巢综合征(PCOS)患者发病的相关性及对疗效的预测价值。方法 选取2020年9月至2022年5月在我院接受二甲双胍片＋优思悦治疗的PCOS患者62例为PCOS组,另选取同时期来我院检查健康者50例为对照组,测定两组血清AMH、AD、DHEAS水平,分析与PCOS发生的关系及对疗效的预测价值。结果 研究发现PCOS组胰岛素抵抗指数(HOMA-IR)和血清雄烯二酮(ASD)、睾酮(T)、黄体生成素(LH)、AMH、DHEAS水平明显高于对照组,AD水平明显低于对照组(t值分别为7.808、12.701、13.121、16.717、11.659、17.476和25.391,P＜0.05).多因素Logistic回归分析显示,HOMA-IR(OR＝2.640,95％CI:2.439~9.284)、AMH(OR＝2.635,95％CI:1.458~4.763)、DHEAS(OR＝1.087,95％CI:1.033~1.143)为PCOS发病独立危险因素,AD(OR＝0.505,95％CI:0.286~0.891)为保护因素(P＜0.05).有效组血清AMH、DHEAS水平明显低于无效组,AD水平明显高于无效组(t值分别为5.049、5.641和5.704,P＜0.05).受试者工作特征(ROC)曲线显示,血清AMH＋AD＋DHEAS水平[曲线下面积(AUC)＝0.909,95％CI:0.804~0.969]预测PCOS患者疗效的敏感度、特异度、准确度均高于AMH(AUC＝0.795,95％CI:0.668~0.889)、AD(AUC＝0.765,95％CI:0.635~0.866)、DHEAS(AUC＝0.750,95％CI:0.619~0.854)单独预测。结论 PCOS患者血清AMH、DHEAS、AD联合检测可能为预测临床疗效和明确病因提供佐证.

Abstract

Objective To investigate the correlation between serum anti-Müllerian hormone (AMH), adropin (AD) and dehydroepiandrosterone sulphate (DHEAS) expression with the onset of polycystic ovary syndrome (PCOS) patients and its predictive value for treatment efficacy. Methods 62 PCOS patients who received metformin tablets combined with drospirenone and ethinyl estradiol tablets (Ⅱ) treatment at our hospital from September 2020 to May 2022 were selected as the PCOS group, and 50 healthy individuals who underwent examinations at our hospital during the same period were selected as the control group. The serum AMH, AD and DHEAS levels of the two groups were measured to analyze their relationship with PCOS onset and the predictive value for treatment efficacy. Results The study found that in the PCOS group, the HOMA-insulin resistance index (HOMA-IR) and serum androstenedione (ASD), testosterone (T), luteinizing hormone (LH), AMH and DHEAS levels were significantly higher than those in the control group, and AD levels were significantly lower than those in the control group (t=7.808, 12.701, 13.121, 16.717, 11.659, 17.476, and 25.391, respectively, all P＜0.05). Multivariate logistic regression analysis showed that HOMA-IR (OR=2.640, 95%CI: 2.439-9.284), AMH (OR=2.635, 95%CI: 1.458-4.763) and DHEAS (OR=1.087, 95%CI: 1.033-1.143) were independent risk factors for PCOS onset, while AD (OR=0.505, 95%CI: 0.286–0.891) was a protective factor (P＜0.05). Serum AMH and DHEAS levels in the effective treatment group were significantly lower than those in the ineffective group, and AD levels were significantly higher than those in the ineffective group (t=5.049, 5.641, and 5.704, respectively, all P＜0.05). The receiver operating characteristic (ROC) curves analysis showed that the sensitivity, specificity and accuracy of predicting treatment efficacy in PCOS patients using serum AMH+AD+DHEAS levels [area under the curve (AUC)=0.909, 95%CI=0.804-0.969] were higher than those of AMH alone (AUC=0.795, 95%CI: 0.668-0.889), AD alone (AUC=0.765, 95%CI: 0.635-0.866), and DHEAS (AUC=0.750, 95%CI: 0.619-0.854). Conclusions Combined detection of serum AMH, DHEAS, and AD in PCOS patients may provide evidence for predicting clinical efficacy and clarifying etiology.

关键词

多囊卵巢综合征 / 抗缪勒管激素 / adropin蛋白 / 硫酸脱氢表雄酮 / 疗效 / 预测价值

Key words

polycystic ovary syndrome / anti-Müllerian hormone / adropin protein / dehydroepiandrosterone sulfate / curative effect / predictive value

参考文献

[1] 多囊卵巢综合征诊治路径专家共识编写组 ． 多囊卵巢综合征诊治路径专家共识[J]． 中华生殖与避孕杂志, 2023, 43(4): 337-345．

[2] 多囊卵巢综合征相关不孕治疗及生育保护共识专家组, 中华预防医学会生育力保护分会生殖内分泌生育保护学组 ． 多囊卵巢综合征相关不孕治疗及生育保护共识[J]． 生殖医学杂志, 2020, 29(7): 843-851．

[3] 牛静云, 侯丽辉, 寇丽辉, 等 ． 不同高雄激素血症表型多囊卵巢综合征患者临床特征分析[J]． 实用妇产科杂志, 2018, 34(4): 286-290．

[4] Siddiqui S, Mateen S, Ahmad R, et al. A brief insight into the etiology, genetics, and immunology of polycystic ovarian syndrome (PCOS)[J]. J Assist Reprod Genet, 2022, 39(11): 2439-2473.

[5] Kuliczkowska-Płaksej J, Mierzwicka A, Jończyk M, et al. Adropin in women with polycystic ovary syndrome[J]. Endokrynol Pol, 2019, 70(2): 151-156.

[6] Nadir A, Temizkan S, Ozderya A, et al. Dehydroepiandrosterone sulfate/free androgen index ratio predicts a favorable metabolic profile in patients with polycystic ovary syndrome[J]. Gynecol Endocrinol, 2019, 35(2): 128-132.

[7] Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)[J]. Hum Reprod, 2004, 81(1): 19-25.

[8] Li R, Zhang Q, Yang D, et al. Prevalence of polycystic ovary syndrome in women in China: a large community-based study[J]. Hum Reprod, 2013, 28(9): 2562-2569.

[9] Eiras M C, Pinheiro D P, Romcy K A M, et al. Polycystic ovary syndrome: the epigenetics behind the disease[J]. Reprod Sci, 2022, 29(3): 680-694.

[10] 熊丽, 邹洁宁, 王瑞玲, 等 ． 枸橼酸氯米芬联合HCG治疗对PCOS患者AMH水平和排卵率的影响[J]． 中南医学科学杂志, 2022, 50(4): 572-575．

[11] Almeida F R C L, Costermans N G J, Soede N M, et al. Presence of anti-Müllerian hormone (AMH) during follicular development in the porcine ovary[J]. PLoS One, 2018, 13(7): e0197894.

[12] 周密, 丁旭, 黄艳红 ． 抗苗勒管激素与多囊卵巢综合征生殖内分泌的关系[J]． 中国妇幼健康研究, 2017, 28(11): 1490-1493．

[13] 唐振香, 余丽金, 平玉珍, 等 ． 多囊卵巢综合征患者血清miR-194-3p、miR-296-3p和AMH水平及其诊断价值[J]． 中国妇幼健康研究, 2022, 33(12): 57-62．

[14] Butler A A, Zhang J, Price C A, et al. Low plasma adropin concentrations increase risks of weight gain and metabolic dysregulation in response to a high-sugar diet in male nonhuman primates[J]. J Biol Chem, 2019, 294(25): 9706-9719.

[15] Zang H, Jiang F, Cheng X, et al. Serum adropin levels are decreased in Chinese type 2 diabetic patients and negatively correlated with body mass index[J]. Endocr J, 2018, 65(7): 685-691.

[16] Akcılar R, Emel Koçak F, Şimşek H, et al. The effect of adropin on lipid and glucose metabolism in rats with hyperlipidemia[J]. Iran J Basic Med Sci, 2016, 19(3): 245-251.

[17] 吴鑫 ． 不同表型多囊卵巢综合征与AMH、性激素、DHEAs、AND之间的相关性研究[D]． 新疆医科大学, 2023．

基金资助

山西省儿童医院课题基金(2021011)