多囊卵巢综合征患者血清DHEA-S、SHBG、17α-OHP检测的临床意义

doi:10.3969/j.issn.1673-8640.2024.05.009

摘要/Abstract

摘要：

目的探讨多囊卵巢综合征（PCOS）患者血清硫酸脱氢表雄酮（DHEA-S）、性激素结合球蛋白（SHBG）和17α-羟孕酮（17α-OHP）检测的临床意义。方法选取2020年1月1日—2023年3月8日上海市奉贤区奉城医院PCOS患者110例（PCOS组）、同期体检健康女性550名（正常对照组）。检测所有研究对象血清DHEA-S、SHBG和17α-OHP水平。采用多因素Logistic回归分析评估PCOS发生的危险因素。采用受试者工作特征（ROC）曲线评价DHEA-S、SHBG、17α-OHP诊断PCOS的效能。结果 PCOS组血清DHEA-S和17α-OHP水平均显著高于正常对照组（P<0.01），SHBG水平显著低于正常对照组（P<0.01）。多因素Logistic回归分析结果显示，DHEA-S、SHBG和17α-OHP均是PCOS发生的危险因素[比值比（OR）值分别为3.546、0.931、5.742，95%可信区间（CI）分别为1.504~8.448、0.882~0.982、1.869~17.648，P<0.01]。DHEA-S、SHBG、17α-OHP单项检测和联合检测诊断PCOS的曲线下面积（AUC）分别为0.823、0.868、0.869、0.968。结论 PCOS患者血清DHEA-S和17α-OHP水平显著升高，SHBG水平显著降低，三者联合检测在PCOS的辅助诊断中有较高的临床价值。

关键词: 硫酸脱氢表雄酮, 性激素结合球蛋白, 17α-羟孕酮, 多囊卵巢综合征

Abstract:

Objective To investigate the clinical roles of serum dehydroepiandrosterone sulfate（DHEA-S），sex hormone-binding globulin（SHBG） and 17 alpha-hydroxyprogesterone（17α-OHP） levels in patients with polycystic ovary syndrome（PCOS）. Methods A total of 110 PCOS patients（PCOS group） and 550 healthy females（healthy control group） were enrolled from Fengcheng Hospital of Fengxian District from January 1，2020 to March 8，2023. Serum levels of DHEA-S，SHBG and 17α-OHP were determined. Multivariate Logistic regression analysis was used to evaluate the risk factors of PCOS. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of DHEA-S，SHBG and 17α-OHP in the diagnosis of PCOS. Results The serum DHEA-S and 17α-OHP levels in PCOS group were higher than those in healthy control group（P<0.01），and serum SHBG levels were lower than those in healthy control group（P<0.01）. DHEA-S，SHBG and 17α-OHP were all risk factors for PCOS [odds ratios（OR） were 3.546，0.931 and 5.742，95% confidence intervals（CI） were 1.504~8.448，0.882~0.982，1.869~17.648，respectively，P<0.01]. The areas under curves（AUC） of DHEA-S，SHBG and 17α-OHP for the diagnosis of PCOS were 0.823，0.868，0.869 and 0.968，respectively. Conclusions Serum DHEA-S and 17α-OHP levels in PCOS patients are increased，while SHBG levels are decreased. The combined determination of DHEA-S，SHBG and 17α-OHP levels in PCOS patients has high clinical value in the auxiliary diagnosis of PCOS.

Key words: Dehydroepiandrosterone sulfate, Sex hormone-binding globulin, 17 Alpha-hydroxyprogesterone, Polycystic ovary syndrome

中图分类号:

R446.1

杜金龙, 芦弘. 多囊卵巢综合征患者血清DHEA-S、SHBG、17α-OHP检测的临床意义[J]. 检验医学, 2024, 39(5): 464-467.

DU Jinlong, LU Hong. Clinical roles of serum DHEA-S，SHBG and 17α-OHP in patients with polycystic ovary syndrome[J]. Laboratory Medicine, 2024, 39(5): 464-467.

图/表 4

参考文献 18

[1]	毛伟维, 刘承东, 刘雪玲, 等. 多囊卵巢综合征病因病机及治疗的最新研究进展[J]. 江苏大学学报(医学版), 2023, 33(3):198-205.
[2]	TEEDE H J, MISSO M L, COSTELLO M F, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome[J]. Hum Reprod, 2018, 33(9):1602-1618.
[3]	TEEDE H J, MISSO M L, COSTELLO M F, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome[J]. Fertil Steril, 2018, 110(3):364-379. DOI PMID
[4]	ABSATAROVA Y S, EVSEEVA Y S, ANDREEVA E N. Neuroendocrine features of the pathogenesis of polycystic ovary syndrome(literature review)[J]. Probl Endokrinol(Mosk), 2023, 69(5):107-114.
[5]	BAILLARGEON J P, CARPENTIER A. Role of insulin in the hyperandrogenemia of lean women with polycystic ovary syndrome and normal insulin sensitivity[J]. Fertil Steril, 2007, 88(4):886-893.
[6]	周勤英, 崔艳华, 王秋香. PCOS患者血清DHEAS与SHBG变化与患者胰岛素抵抗的关系[J]. 实验与检验医学, 2021, 39(3):573-576.
[7]	CARMINA E, LONGO R A. Increased prevalence of elevated DHEAS in PCOS women with non-classic(B or C)phenotypes:a retrospective analysis in patients aged 20 to 29 years[J]. Cells, 2022, 11(20):3255.
[8]	BONGRANI A, PLOTTON I, MELLOUK N, et al. High androgen concentrations in follicular fluid of polycystic ovary syndrome women[J]. Reprod Biol Endocrinol, 2022, 20(1):88.
[9]	Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome[J]. Fertil Steril, 2004, 81(1):19-25. DOI PMID
[10]	GILBERT E W, TAY C T, HIAM D S, et al. Comorbidities and complications of polycystic ovary syndrome:an overview of systematic reviews[J]. Clin Endocrinol(Oxf), 2018, 89(6):683-699.
[11]	JOHAM A E, NORMAN R J, STENER-VICTORIN E, et al. Polycystic ovary syndrome[J]. Lancet Diabetes Endocrinol, 2022, 10(9):668-680.
[12]	KHAN S H, RIZVI S A, SHAHID R, et al. Dehydroepiandrosterone sulfate(DHEAS)levels in polycystic ovarian syndrome(PCOS)[J]. Jcpsp-J Coll Physici, 2021, 31(3):253-257.
[13]	张蓓, 魏薇, 杨璨. AMH、DHEA-S、LH、FSH在多囊卵巢综合征患者血清中的表达及临床意义[J]. 贵州医药, 2022, 46(1):126-127.
[14]	URBANO F, CHIARITO M, LATTANZIO C, et al. Sex hormone-binding globulin(SHBG)reduction:the alarm bell for the risk of non-alcoholic fatty liver disease in adolescents with polycystic ovary syndrome[J]. Children(Basel), 2022, 9(11):1748.
[15]	ZAREI E, BINABAJ M M, ZADEH F M. Kisspeptin levels in relation to sex hormone profile among PCOS patients[J]. Ir J Med Sci, 2022, 191(4):1711-1716.
[16]	MAGAGNINI M C, CONDORELLI R A, CIMINO L, et al. Does the ketogenic diet improve the quality of ovarian function in obese women?[J]. Nutrients, 2022, 14(19):4147.
[17]	YESILADALI M, YAZICI M G K, ATTAR E, et al. Differentiating polycystic ovary syndrome from adrenal disorders[J]. Diagnostics(Basel), 2022, 12(9):2045.
[18]	叶青, 刘艳, 欧阳凯, 等. 多囊卵巢综合征患者血清DHEA-S与SHBG检测的临床意义[J]. 热带医学杂志, 2014, 14(10):1309-1311.

组别	例数	DHEA-S/（μg·mL^-1）	SHBG/（nmol·L^-1）	17α-OHP/（ng·mL^-1）
PCOS组	110	3.44±0.91	38.32±14.12	5.19±2.08
正常对照组	550	2.11±0.80	61.48±21.31	2.89±1.02
t值		3.839	-5.833	2.735
P值		<0.01	<0.01	<0.01

组别	例数	DHEA-S/（μg·mL^-1）	SHBG/（nmol·L^-1）	17α-OHP/（ng·mL^-1）
PCOS组	110	3.44±0.91	38.32±14.12	5.19±2.08
正常对照组	550	2.11±0.80	61.48±21.31	2.89±1.02
t值		3.839	-5.833	2.735
P值		<0.01	<0.01	<0.01

项目	β值	标准误	Wald值	P值	OR值（95%CI）
DHEA-S	1.271	0.440	8330	0.004	3.546（1.504~8.448）
SHBG	-0.072	0.027	6.929	0.008	0.931（0.882~0.982）
17α-OHP	1.748	0.573	9.311	0.002	5.742（1.869~17.648）

项目	β值	标准误	Wald值	P值	OR值（95%CI）
DHEA-S	1.271	0.440	8330	0.004	3.546（1.504~8.448）
SHBG	-0.072	0.027	6.929	0.008	0.931（0.882~0.982）
17α-OHP	1.748	0.573	9.311	0.002	5.742（1.869~17.648）

项目	AUC（95%CI）	最佳临界值	敏感性/%	特异性/%	约登指数
DHEA-S	0.823（0.734~0.912）	2.06 μg·mL^-1	87.3	66.7	0.540
SHBG	0.868（0.794~0.942）	49.75 nmol·L^-1	90.9	66.7	0.576
17α-OHP	0.869（0.792~0.947）	3.50 ng·mL^-1	80.0	90.9	0.709
联合检测	0.968（0.937~0.999）	0.945	94.5	93.4	0.879