临床中需要频繁使用超声来诊断PCOS吗？

美国生殖医学会（ASRM）年会是生殖医学领域规模最大、最具影响力的年度国际学术会议之一，覆盖生殖医学领域所有专业。生殖医学论坛精选了众多会议精华内容进行了翻译，希望给大家带来最新鲜、最前沿的生殖医学资讯。

OBJECTIVE

目的

To assess the utility of ultrasound to rule in or rule out the diagnosis of PCOS by Rotterdam criteria in a population presenting for evaluation of hyperandrogenism to a tertiary care clinic.

评估在一家三级医疗诊所就诊的高雄激素症评估人群中，通过鹿特丹标准来确定PCOS的诊断结果，确定超声在确认或排除PCOS诊断方面的实用性。

MATERIALS AND METHODS

材料与方法

Subjects were 619 patients consecutively seen in a tertiary care referral clinic, aged 14-45 yrs., in whom other causes of hyperandrogenism, including thyroid dysfunction, hyperprolactinemia, non-classic adrenal hyperplasia, were ruled out. Subjects were evaluated with a complete history and physical, modified Ferriman Gallwey (mFG) scoring, and serum testing for total testosterone (T), free T, and DHEAS. Patients also underwent transvaginal ultrasound (TV-US) to assess ovarian volume and morphology. Polycystic ovarian morphology (PCOM) was identified as an antral follicle count (AFC) ≥20 in at least one ovary and/or ovarian volume >10 mL. PCOS was defined by Rotterdam criteria and deemed present if subjects were positive for at least two of three: biochemical or clinical hyperandrogenism (HA), ovulatory dysfunction (OD), and polycystic ovarian morphology (PCOM). Subjects were then classified into phenotypes: Phenotype A = HA+OD+PCOM, Phenotype B = HA+OD, Phenotype C = HA+PCOM, and Phenotype D = OD+PCOM. Subjects were excluded from analysis if mFG scoring was unavailable, if they failed to provide menstrual history, or if they were positive for either HA or OD alone and did not undergo transvaginal ultrasound. Statistics were calculated using Fisher’s Exact Test.

本研究连续招募了619名患者，年龄在14-45岁之间，就诊于三级医疗转诊门诊。这些患者经过排除其他原因引起的高雄激素增多症，包括甲状腺功能障碍、催乳素增高和非典型肾上腺增生等。研究对象通过详细的个人病史和体格检查、修正的Ferriman Gallwey（mFG）评分以及血清检测总睾酮（T）、游离睾酮和去氢表雄酮（DHEAS）进行评估。同时，患者还接受了经阴道超声检查（TV-US），评估卵巢体积和形态。卵巢多囊样改变（PCOM）被定义为至少一个卵巢内的窦卵泡数（AFC）≥20和/或卵巢体积＞10 mL。根据Rotterdam标准，若患者在以下三项中至少有两项阳性，则确定为PCOS：生化或临床高雄激素增多症（HA）、排卵功能障碍（OD）和卵巢多囊样改变（PCOM）。然后将患者分为不同的表型：A型为HA+OD+PCOM，B型为HA+OD，C型为HA+PCOM，D型为OD+PCOM。若mFG评分不可用、未提供月经史或仅有HA或OD其中一项阳性且未进行经阴道超声检查的患者将被排除在分析之外。统计学参数使用Fisher精确检验进行计算。

RESULTS

结果

In total, 494 subjects were included in the analysis. 417 were classified as phenotype A/B (‘classic PCOS’) and did not require TV-US for diagnosis. Thirty-eight subjects had HA alone and 25 (65.8%) were classified as phenotype C after demonstrating PCOM. Thirty-nine subjects had OD alone, 25 (64.1%%) of which were classified as phenotype D based on the presence of PCOM. No significant difference was found in the rates of PCOM between subjects with HA alone or OD alone.

共有 494 名受试者参与了分析。417 人被归类为表型 A/B（“典型多囊卵巢综合征”），无需 TV-US 诊断。38名受试者仅有HA，25名（65.8%）在显示PCOM后被归类为表型C。39 名受试者仅有 OD，其中 25 人（64.1%）根据 PCOM 的存在被归类为表型 D。仅有 HA或仅有 OD 的受试者之间的 PCOM 发生率没有明显差异。

CONCLUSIONS

结论

While ultrasound is a useful tool in the diagnosis of PCOS by the Rotterdam criteria, in our referral population only 15.6% required a TV-US to rule in or rule out the diagnosis of PCOS with Phenotypes C or D. There did not appear to be a significant difference in the likelihood of PCOM between Phenotypes C and D in this population.

虽然经阴道超声在根据鹿特丹标准诊断PCOS方面是一个有用的工具，但在我们的转诊人群中，只有15.6%的患者需要进行经阴道超声来确认或排除C型或D型PCOS的诊断。在这个人群中，C型和D型之间的PCOM发生率似乎没有显著差异。

IMPACT STATEMENT

影响声明

When assessing women for the presence or absence of PCOS, a thorough history, physical, and androgen panel will often be diagnostic, allowing transvaginal ultrasound to be reserved for those cases in which the diagnosis is uncertain.

在评估妇女是否患有多囊卵巢综合征时，详尽的病史、体格检查和雄激素检查通常就能做出诊断，经阴道超声检查可用于诊断不明确的病例。

文章来源：

HOW FREQUENTLY IS ULTRASOUND REQUIRED TO DIAGNOSE THE PRESENCE OR ABSENCE OF POLYCYSTIC OVARIAN SYNDROME (PCOS) IN A CLINICAL POPULATION?Pace, Lauren et al.Fertility and Sterility, Volume 120, Issue 4, e161 - e162