重庆地区正常育龄期女性雄激素水平初探及在多囊卵巢综合征中的诊断价值

发布时间：2018-07-13 19:45

【摘要】：第一部分重庆地区正常育龄期女性雄激素水平初探目的：了解重庆地区正常育龄期女性总睾酮(total testosterone, TT)、游离睾酮(free testosteronem, FT)、游离雄激素指数(free androgen index, FAI)、硫酸脱氢表雄酮(dehydroepiandrosterone sulfate, DHEAS)的个体值分布范围。方法：于2007年10月至2012年8月招募健康成年女性121名,检测其血清TT、DHEAS、性激素结合球蛋白(sex hormone binding globulin, SHBG)水平,计算FT (calculated free testosterone, cFT)及FAI的值,对正态分布指标采用(x±1.96s)、对非正态分布指标采用百分位数法(P2.5和P97.5)建立各指标95%的个体值分布范围。结果：(1)成年女性雄激素指标TT、cFT、DHEAS呈正态分布,平均水平TT为(0.46±0.16) ng/ml, cFT为(5.92±2.80)pg/ml, DHEAS为(222.81±86.82)μg/dl, FAI呈右偏态分布,中位数及四分位间距为2.60%(1.87%-3.56%)。(2)TT的95%个体值分布范围为0.15～0.77ng/ml, cFT的95%个体值分布范围为0.43～11.40 pg/ml, FAI的95%个体值分布范围为0.90%-9.34%,DHEAS的95%个体值分布范围为52.64-392.98 μg/dl。结论：初步建立了重庆地区正常育龄期女性TT、cFT、FAI、DHEAS的个体值分布范围。第二部分不同雄激素指标在多囊卵巢综合征中的诊断价值目的：探讨总睾酮(total testosterone, TT)、游离睾酮(free testosteronem, FT)、游离雄激素指数(free androgen index, FAI)、硫酸脱氢表雄酮(dehydroepiandrosterone sulfate, DHEAS)对多囊卵巢综合征(PCOS)的诊断价值。方法：纳入117例PCOS患者及121例年龄匹配的健康女性作为对照,测定血清TT、DHEAS、性激素结合球蛋白(sex hormone binding globulin, SHBG),并计算FT (calculated free testosterone, cFT)及FAI的值。比较各指标ROC曲线下面积,并确定其诊断PCOS的最佳切点值。结果：(1)PCOS组TT、cFT、FAI均高于正常组,差异有统计学意义(P0.01)；DHEAS在两组间的差异无统计学意义。(2)TT、cFT、 FAI、DHEAS的ROC曲线下面积(AUC)分别为0.742±-0.033,0.735±0.036,0.731±0.036,0.589±0.037。TT、cFT、FAI的AUC两两相比较,差异均无统计学意义；DHEAS的AUC较其他3项指标小,差异有统计学意义。(3)TT为0.63 ng/ml时,其诊断的灵敏度为51.79%,特异度为85.83%：cFT为7.97 pg/ml时,其诊断的灵敏度为64.29%,特异度为85%；FAI为4.52%时,其诊断的灵敏度为58.93%,特异度为89.17%；DHEAS为229.8μg/ml时,其诊断的灵敏度为54.46%,特异度为60.83%。结论：TT、cFT、FAI对于PCOS的诊断价值相当,其切点值分别为0.63 ng/ml、7.97 pg/ml、4.52%, DHEAS对于PCOS的诊断价值欠佳。
[Abstract]:Part I: preliminary study on androgen levels in normal women of childbearing age in Chongqing objective: to understand the total testosterone (total testosterone, TT), free testosterone (free testosteronem, FT), free androgen index (free androgen index, FAI) and dehydroepiandrosterone sulfate (DHEA) in women of normal reproductive age in Chongqing area. The individual value distribution range of (dehydroepiandrosterone sulfate, DHEAS. Methods: from October 2007 to August 2012, 121 healthy adult women were recruited. The serum levels of TTX DHEASand sex hormone binding globulin (sex hormone binding globulin, SHBG) were measured, and FT (calculated free testosterone, cFT) and FAI values were calculated. For normal distribution index (x 卤1.96 s), for non-normal distribution index, percentile method (P2.5 and P97.5) was used to establish the range of individual value distribution of 95%. Results: (1) the androgen index TTHEAS of adult women showed normal distribution, the average TT was (0.46 卤0.16) ng / ml, the CFT was (5.92 卤2.80) PG / ml, the DHEAS was (222.81 卤86.82) 渭 g / dl. The median and quartile spacing is 2.60% (1.87-3.56%). (2) TT 95% individual value distribution range is 0.15ng / ml, CFT 95% individual value distribution range is 0.4340pg / ml, FAI 95% individual value distribution range is 0.90-9.34DHEAS 95% individual value distribution range is 52.64-392.98 渭 g / dl. Conclusion: the distribution range of DHEAS in normal childbearing age women in Chongqing area was preliminarily established. The second part: the diagnostic value of different androgen indexes in polycystic ovary syndrome objective: to investigate the diagnostic value of total testosterone (total testosterone, TT), free testosterone (free testosteronem, FT), free androgen index (free androgen index, FAI) and dehydroepiandrosterone sulfate (dehydroepiandrosterone sulfate, DHEAS) in polycystic ovary. Diagnostic value of PCOS. Methods: a total of 117 patients with PCOS and 121 age-matched healthy women were included as controls. The serum TTX DHEASand sex hormone binding globulin (sex hormone binding globulin, SHBG) were measured, and FT (calculated free testosterone, CFT) and FAI values were calculated. The area under the ROC curve was compared and the optimum value of the tangent point for PCOS diagnosis was determined. Results: (1) there was no significant difference between the two groups (P0.01). (2) the areas under the ROC curve of TTCFTand FAIHEAS were 0.742 卤-0.030.735 卤0.036 卤0.731 卤0.036 卤0.036 卤0.589 卤0.037. TTHEAS had no significant difference between the two groups. (3) when TT was 0.63 ng/ml, the diagnostic sensitivity was 51.79 and the specificity was 85.83%. The sensitivity was 64.29 and the specificity was 4.52 when the TTT was 0.63 ng/ml. The diagnostic sensitivity was 58.93 and the specificity was 89.17. When DHEAS was 229.8 渭 g/ml, the diagnostic sensitivity was 54.46 and the specificity was 60.83. Conclusion the diagnostic value of FT-FAI for PCOS is the same. The cut-point value is 0.63 ng / ml ~ (-1) 7.97 PG / ml ~ (4.52), respectively. DHEAS is not good in the diagnosis of PCOS.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R711.75

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