摘要目的:探讨抗苗勒管激素(AMH)联合性激素诊断多囊卵巢综合征(PCOS)的临床价值及在年龄分层中的意义。方法:选取临汾市中心医院2015年1月至2018年12月收治的PCOS患者164例(PCOS组)和体检健康女性120例(对照组)的临床资料，比较两组年龄、性激素指标及AMH水平，分析单一指标和联合检测诊断PCOS临床效能，同时评价AMH水平与年龄、性激素指标间相关性，观察年龄分层对PCOS诊断的影响。结果:PCOS组血清AMH、睾酮(T)、黄体生成素(LH)及LH/卵泡刺激素(FSH)比值分别为(62.90±5.19)pmol/L、(1.36±0.55)nmol/L、(12.86±2.4)IU/L、(2.27±0.86)，均显著高于对照组的(27.22±3.72)pmol/L、(0.87±0.30)nmol/L、(6.41±1.18)IU/L、(1.15±0.53)( t＝7.38、3.76、5.15、3.89，均 P<0.05)；AMH诊断PCOS的灵敏度均显著高于LH和LH/FSH比值(χ 2＝5.72、14.10，均 P<0.05)；AMH＋T、AMH＋LH、AMH＋T＋LH联合检测的灵敏度分别为89.02%、87.80%、95.12%，均显著高于AMH单独检测的80.49%(χ 2＝5.67、4.33、10.94，均 P<0.05)；AMH、T、LH、LH/FSH比值诊断PCOS特异度差异无统计学意义(χ 2＝0.38， P>0.05)；同时AMH单独、AMH＋T、AMH＋LH、AMH＋LH/FSH比值及AMH＋T＋LH联合诊断PCOS特异度差异无统计学意义(χ 2＝0.45， P>0.05)；AMH诊断PCOS曲线下面积(AUC)为0.846，均显著高于T、LH、LH/FSH比值的0.714、0.765、0.783( Z＝2.09、2.43、2.20，均 P<0.05)；Spearman相关性分析显示，PCOS组AMH水平与T、LH及LH/FSH比值均呈正相关( r＝0.27、0.25、0.33，均 P<0.05)；对照组AMH水平与年龄呈负相关( r＝－0.33， P<0.05)；AMH诊断PCOS临界值随年龄增加而降低，25～29岁组和30～37岁组AMH诊断PCOS的灵敏度、特异度及受试者工作特征-AUC高于全人群。 结论:AMH＋T或AMH＋LH或三者联用有助于提高PCOS诊断灵敏度，但特异度与单纯AMH诊断接近；针对AMH临界值行年龄分层有助于提高PCOS诊断准确度。

abstractsObjective:To investigate the clinical value and age stratification significance of anti-mullerian hormone (AMH) combined with sex hormone in the diagnosis of patients with polycystic ovary syndrome (PCOS).Methods:The clinical data of 164 patients with PCOS(PCOS group) and 120 healthy women(control group) were retrospectively chosen from January 2015 to December 2018.The age, sex hormone index levels and AMH levels of the two groups were compared.The clinical efficacy of single index and combined index detection in the diagnosis of PCOS were analyzed.The correlation between AMH level and age, sex hormone index was evaluated and the influence of age stratification on the diagnosis of PCOS was observed.Results:The levels of AMH, T, LH and LH/FSH ratio in the PCOS group were (62.90±5.19)pmol/L, (1.36±0.55)nmol/L, (12.86±2.4)IU/L, (2.27±0.86), respectively, which were significantly higher than those in the control group [(27.22±3.72)pmol/L, (0.87±0.30)nmol/L, (6.41±1.18)IU/L, (1.15±0.53)] ( t=7.38, 3.76, 5.15, 3.89, all P<0.05). The sensitivity of AMH in the diagnosis of PCOS was significantly higher than LH and LH/FSH(χ 2=5.72, 14.10, all P<0.05). The sensitivity of AMH+ T, AMH+ LH and AMH+ T+ LH were 89.02%, 87.80%, 95.12%, respectively, which were significantly higher than AMH alone (80.49%)(χ 2=5.67, 4.33, 10.94, all P<0.05). There was no significant ststistically difference among AMH, T, LH and LH/FSH in the diagnosis of PCOS(χ 2=0.38, P>0.05). There was no significant ststistically difference in the specificity of AMH alone, AMH+ T, AMH+ LH, AMH+ LH/FSH and combination of AMH+ T+ LH in the diagnosis of PCOS(χ 2=0.45, P>0.05). The AUC of AMH in diagnosis of PCOS was 0.86, which was significantly higher than T, LH and LH/FSH(0.714, 0.765, 0.783)( Z=2.09, 2.43, 2.20, all P<0.05). Spearman correlation analysis showed that there was positive correlation between AMH level and T, LH, LH/FSH in PCOS group ( r=0.27, 0.25, 0.33, all P<0.05). There was negative correlation between AMH level and age in healthy group( P>0.05). The critical value of AMH in diagnosis of PCOS was decreased with the increase of age.The sensitivity, specificity and ROC-AUC of AMH in 25-29 years old group and 30-37 years old group were higher than whole population( r=-0.33, P<0.05). Conclusion:The combination of AMH+ T, AMH+ LH or AMH+ T+ LH can improve the diagnosis sensitivity of PCOS, but the specificity is similar to AMH alone; then age stratification for the AMH critical value can increase the diagnosis accuracy of PCOS.