Specificity and predictive value of circulating testosterone assessed by tandem mass spectrometry for the diagnosis of polycystic ovary syndrome by the National Institutes of Health 1990 criteria.
Specificity and predictive value of circulating testosterone assessed by tandem mass spectrometry for the diagnosis of polycystic ovary syndrome by the National Institutes of Health 1990 criteria.
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DOI：
10.1016/j.fertnstert.2013.12.056
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发表时间：
2014-04
影响因子：
6.7
通讯作者：
Reitz, Richard E.
中科院分区：
文献类型：
--
作者：
Salameh, Wael A.;Redor-Goldman, Mildred M.;Clarke, Nigel J.;Mathur, Ruchi;Azziz, Ricardo;Reitz, Richard E.
目的：探讨LC-MS/MS测定总(TT)和游离(FT)睾酮是否比萃取-放射免疫分析(RIA)更具特异性，以区分多囊卵巢综合征(PCOS)患者和正常对照，并根据不同的环境选择不同的临界值。前瞻性病例对照队列研究。三级护理中心和参考实验室。采血。100例多囊卵巢综合征患者和100例对照组。循环TT用RIA和LC-MS/MS测量，FT用RIA或LC-MS/MS产生的TT值平衡透析法测量。用放射免疫法和LC-MS/MS法测定睾酮水平可将PCOS与对照组进行相似的区分；两种方法对多囊卵巢综合征的检出均高于FT。在RIA(80%对42%重叠)和LC-MS/MS(52%对67%重叠)中，TT值显示PCOS和对照之间有更大的重叠。较低的临界值更适合于在临床(参考)环境中看到的患者的研究(TT和FT分别为35 ng/dL和4.0 ng/dL)，而不是在一般人群筛查中(TT和FT分别为50 ng/dL和5.0 ng/dL)。睾酮的提取层析、RIA和LC-MS/MS测量在区分多囊卵巢综合征和健康对照方面具有类似的性能；LC-MS/MS可能更可取，因为它相对容易自动化。与FT相比，TT对PCOS与正常对照的鉴别诊断价值相对有限。最后，应根据临床/研究环境考虑不同的分界值，在对有偏见(如临床或参考)人群的研究中使用较高的分界值。
To determine whether liquid chromatography–tandem mass spectrometry (LC-MS/MS) determination of total (TT) and free (FT) testosterone is more specific than extraction chromatography–radioimmunoassay (RIA) for distinguishing women with polycystic ovary syndrome (PCOS) from controls, and whether differing cut-off values should be used depending on the setting. Prospective case-control cohort study. Tertiary care center and reference laboratory. Blood sampling. 100 PCOS patients and 100 controls. Circulating TT measured by RIA and LC-MS/MS, and FT measured by equilibrium dialysis using the RIA or LC-MS/MS-generated TT values. Testosterone measurement by RIA and LC-MS/MS differentiated PCOS from controls similarly; detection of PCOS was higher for FT for both methods. TT values demonstrated greater overlap between PCOS and controls than did FT for both RIA (80% vs. 42% overlap) and LC-MS/MS (52% vs. 67% overlap). A lower cut-off value was better suited for the study of patients seen in the clinical (referred) setting (35 ng/dL and 4.0 ng/dL for TT and FT, respectively) than in the screening of a general population (50 ng/dL and 5.0 ng/dL for TT and FT, respectively). Extraction chromatography and RIA and LC-MS/MS measurements of testosterone have similar performance for differentiating PCOS from healthy controls; LC-MS/MS may be preferable given its relative ease of automation. Compared to FT, measurement of TT has relatively limited value for distinguishing PCOS from normal. Finally, different cut-off values should be considered depending on the clinical/investigative setting, with higher values used in the study of biased (e.g. clinical or referred) populations.
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