The value of serum anti-Müllerian hormone combined with sex hormones for polycystic ovary syndrome diagnosis

Objective To investigate the diagnostic value of serum anti-Mullerian hormone combined with sex hormones for polycystic ovary syndrome (PCOS). Methods The serum levels of anti-Mullerian hormone (AMH), testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and the estradiol (E2) were measured by electrochemiluminescence method in 82 patients with PCOS and 60 controls. The sensitivities, specificities and the areas under the receiver operating characteristic curves (ROC-AUC) of the indicators and their combination for diagnosis of PCOS were compared by chi-square test and Z test separately. The correlations of serum AMH levels with age and sex hormones levels were analyzed separately by Spearman correlation analysis. Results The levels of serum AMH, T, LH and LH/FSH ratio in patients with PCOS were obviously higher than those in controls (62.19 pmol/L vs 27.63 pmol/L, 1.39 nmol/L vs 0.88 nmol/L, 12.72 IU/L vs 6.44 IU/L, 2.17 vs 1.17, U=592.00, 1 096.00, 1 233.50, 1 134.00, all P 0.05). The sensitivity of AMH (80.5%, 66/82) increased when combined with T (89.0%, 73/82), LH (87.8%, 72/82) and T+ LH (95.10%, 78/82, χ2=5.14, 4.17, 10.08, all P 0.05). The specificity of AMH (80%, 48/60) for diagnosis of PCOS was no significant difference compared with that of T (71.7%, 43/60), LH (85%, 51/60), and LH/FSH ratio (91.7%, 55/60) (χ2=3.20, 0.36, 2.77, all P>0.05). Also no increase when combined with T (71.7%, 43/60), LH (73.3%, 44/60), LH/FSH (75%, 45/60) and T+ LH (66.7%, 40/60, χ2=3.20, 2.25, 1.33, 3.38, all P>0.05). The ROC-AUC of multiple indicators for diagnosis of PCOS were compared, AMH (0.880) was higher than T, LH and LH/FSH ratio (0.778, 0.760, 0.778, Z=2.12, 2.46, 2.12, all P 0.05). Serum AMH levels were positively correlated with T, LH levels and LH/FSH ratio (r=0.258, 0.241, 0.290, all P 0.05). In the control group, AMH levels had no correlations with T, LH levels 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). The cutoff value of AMH for diagnosis of PCOS decreased with age. Conclusions The sensitivity of AMH for diagnosis of PCOS was 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. Age-stratified cut-off values of AMH were better for accurate diagnosis of PCOS.(Chin J Lab Med, 2018, 41: 456-461) Key words: Polycystic ovary syndrome; Anti-mullerian hormone; Gonadal steroid hormones