早发性卵巢功能不全患者血清ER，AMH 及Cathepsin B 表达水平及临床意义

目的　探究早发性卵巢功能不全（premature ovarian insufficiency，POI）血清抗苗勒管激素(anti-müller-hormon，AMH)、组织蛋白酶B(cathepsin B) 和雌激素受体(estrogen receptor，ER) 水平表达及临床意义。方法　选择2018 年12月～ 2019 年12 月延安大学附属医院收治的121 例POI 患者为病例组，同期体检健康女性50 例为对照组，比较两组血清ER，AMH 和Cathepsin B 水平，采用Spearman 检验分析血清ER，AMH 和Cathepsin B 水平与POI 的相关性，采用受试者工作特征曲线（receiver operating characteristic curve，ROC）分析血清ER，AMH 和Cathepsin B 水平对POI 的预测价值。结果　病例组血清AMH（0.88±0.13ng/ml），ER（9.36±2.26ng/L）水平低于对照组（4.59±1.38ng/ml，23.11±7.48ng/L），差异均有统计学意义（t=34.12，28.52，均P ＜ 0.05）；病例组血清Cathepsin B（3.49±1.23ng/ml）水平高于对照组（0.98±0.12ng/ml），差异有统计学意义（t=25.89，P ＜ 0.05）；血清ER，AMH 水平与POI 呈负相关（r=-0.524，-0.755，均P ＜ 0.05）。Spearman 相关性分析显示，血清Cathepsin B 水平与POI 呈正相关（r=0.810，P ＜ 0.05）。ROC 分析显示，血清ER（AUC=0.743），Cathepsin B（AUC=0.733）水平对POI 的预测价值差异无统计学意义（P ＞ 0.05）；血清AMH 水平对POI 的预测价值明显优于血清ER，Cathepsin B 水平（AUC=0.762，P ＜ 0.05）；血清ER，AMH 和Cathepsin B 水平联合检测对POI 的预测价值明显优于三项指标单独检测（AUC=0.848，P ＜ 0.05）。结论　血清Cathepsin B 在POI 患者中高表达，血清AMH 和ER 在POI 患者中低表达，血清ER，AMH 和Cathepsin B水平联合检测对POI 有较高的预测价值，有助于指导POI 的临床管理。

Expression Level of ER,AMH and Cathepsin B in Serum of Patients with Premature Ovarian Insufficiency and Their Clinical Significance

Objective　To investigate the expression and clinical significance of serum anti-müller-hormon (AMH)，Cathepsin B and estrogen receptor (ER) in premature ovarian insufficiency（POI）. Methods A total of 121 women with POI and 50 healthy women in Affiliated Hospital of Yan’an University from December 2018 to December 2019 were enrolled, and set as case group and control group, respectively. Serum levels of ER, AMH and Cathepsin B were compared between groups. Spearman correlation was used to analyze the correlation between three indicators and POI. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of serum ER, AMH and Cathepsin B on POI. Results　Serum levels of AMH (0.88±0.13ng/ml）and ER（9.36±2.26ng/L) in case group which were significantly lower than in control group(4.59±1.38 ng/ml，23.11±7.48ng/L)，the differences were statistically significant (t=34.120，28.520, all P ＜ 0.05). Serum cathepsin B level was 3.49±1.23ng/ml in case group, which was significantly higher than in control group(0.98±0.12ng/ml)，the difference was statistically significant(t=25.890, P ＜ 0.05). Spearman correlation analysis showed that serum ER and AMH levels were negatively correlated with POI (r=-0.524, -0.755，all P ＜ 0.05), while serum cathepsin B level was positively correlated with POI (r=0.810, P ＜ 0.05). ROC curve indicated that serum AMH had the highest predictive value among there indicators in the diagnosis of premature ovarian failure (P ＜ 0.05), while the predictive value of ER（AUC=0.743）, Cathepsin B（AUC=0.733） had no significant difference (P ＞ 0.05). The predictive value of combined detection of serum ER, AMH and Cathepsin B levels in POI was significantly better than that of single detection (AUC=0.848, P ＜ 0.05). Conclusion　Among patients with POI, serum cathepsin B was highly expressed, while serum AMH and ER were lowly expressed. The combined detection of serum ER,AMH and Cathepsin B levels has a high predictive value for the disease, which can be used to guide the clinical management of POI.