The Relationship Between Insulin Resistance and Obesity and Serum Anti-Mullerian Hormone Level in Chinese Women with Polycystic Ovary Syndrome: A Retrospective, Single-Center Cohort Study

Figures & data

Table 1 PCOS Phenotypes According to Diagnostic Criteria Applied.^5–8

	HA+OA	HA +PCO	OA +PCO
NICHD	+	−	−
Rotterdam	+	+	+
AES	+	+	−
Chinese criteria	+	−	+

Abbreviations: PCO, polycystic ovary; HA, hyperandrogenism; OA, oligomenorrhea.

Figure 1 General characteristics and classification proportion of PCOS population.

Table 2 PCOS General Information and Comparison of PCOS General Information Among Different Age Groups

General Indicators	20 to 29 Years Old(n=131)	30 to 39 Years Old(n=89)	Age Group T	Age Group P	p.Adjust
AMH (ng/mL)	8.90±5.22	6.61±4.61	3.347	0.001^#	0.020*
LH/FSH	1.83±0.91	1.39±0.85	3.615	0.001^#	0.020*
LH (mIU/mL)	11.84±6.24	8.70±5.75	3.774	0.000^#	0.000^#
T(ng/mL)	0.99±0.29	0.50±0.14	15.111	0.000^#	0.000^#
BMI (kg·m^−2)	26.85±4.99	27.75±4.60	−1.359	0.176	1.000
HbA1c (%)	5.93±1.28	5.78±1.09	0.599	0.550	1.000
FPG (mmol/L)	5.64±1.00	5.50±1.33	−1.090	0.277	1.000
FINS (mmol/L)	18.08±10.04	15.23±7.71	2.259	0.025*	0.500
HOMA-IR	4.67±3.33	3.78±2.66	2.110	0.036*	0.720
FSH (mIU/mL)	6.67±2.02	6.32±1.68	1.364	0.174	1.000

Note: *P <0.05, ^#P <0.01. SPSS were used to perform this statistical analysis. All data were tested for normality and homogeneity of variance. Normally distributed data are expressed as means ± standard deviations. Independent sample t-tests were performed to compare two groups, and R software was used to correct P-values.

Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; LH, luteinizing hormone; AMH, anti-mullerian hormone; HOMA-IR, Homeostatic model assessment insulin resistant; T, Total testosterone. FINS, Fasting insulin; FPG, Fasting plasma glucose.

Table 3 Comparison of AMH Levels and Other Indicators Under Different HOMA-IR Conditions

General indicators	NIR (n=94)	IR (n=126)	T	P	p.adjust
AMH (ng/mL)	6.03±3.74	9.39±5.48	−5.121	0.000^#	0.000^#
LH/FSH	1.47±0.77	1.79±0.98	−2.647	0.009^#	0.144
LH (mIU/mL)	9.49±5.77	11.36±6.46	−2.215	0.028*	0.448
T (ng/mL)	0.73±0.31	0.83±0.35	−2.138	0.034*	0.544
Age (years)	28.89±4.32	27.57±4.19	2.255	0.025*	0.400
HbA1c (%)	5.74±1.01	5.96±1.31	−0.905	0.368	1.000
BMI (kg·m^−2)	27.62±4.63	26.91±4.99	1.075	0.284	1.000
FSH (mIU/mL)	6.61±2.23	6.47±1.61	0.521	0.603	1.000

Note: *P <0.05, ^#P <0.01. SPSS were used to perform this statistical analysis. All data were tested for normality and homogeneity of variance. Normally distributed data are expressed as means ± standard deviations. Independent sample t-tests were performed to compare two groups, and R software was used to correct P-values.

Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; LH, luteinizing hormone; AMH, anti-mullerian hormone; HOMA-IR, Homeostatic model assessment insulin resistant; T, Total testosterone. FINS, Fasting insulin; FPG, Fasting plasma glucose; IR, Insulin resistant; NIR, Non-insulin resistant.

Table 4 Comparison of AMH Level and Other Indexes Under Different BMI

General Indicators	Non-Obese Group(n=93)	Obese Group (n=127)	T	P	p.Adjust
AMH (ng/mL)	8.83±5.44	7.35±4.75	2.146	0.033*	0.660
LH/FSH	1.82±0.91	1.54±0.91	2.260	0.025*	0.500
LH (mIU/mL)	11.68±6.30	9.75±6.07	2.298	0.023*	0.460
T (ng/mL)	0.84±0.37	0.76±0.31	1.694	0.092	1.000
Age (years)	27.61±4.15	28.50±4.36	−1.528	0.128	1.000
HbA1c (%)	5.50±0.52	6.04±1.37	−2.137	0.035*	0.700
FPG (mmol/L)	5.73±1.15	5.47±1.14	1.592	0.113	1.000
FINS (mmol/L)	18.61±10.61	15.70±7.94	−0.505	0.614	1.000
HOMA-IR	4.86±3.62	3.91±2.60	−0.172	0.863	1.000
FSH (mIU/mL)	6.58±2.19	6.49±1.65	0.335	0.738	1.000

Note: *P <0.05. SPSS were used to perform this statistical analysis. All data were tested for normality and homogeneity of variance. Normally distributed data are expressed as means ± standard deviations. Independent sample t-tests were performed to compare two groups, and R software was used to correct P-values.

Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; LH, luteinizing hormone; AMH, anti-mullerian hormone; HOMA-IR, Homeostatic model assessment insulin resistant; T, Total testosterone; FINS, Fasting insulin; FPG, Fasting plasma glucose.

Table 5 Comparison of AMH Level and Other Indexes in Different PCOS Phenotypes

Indicators	PCO+OA (n=102)	OA+HA (n=34)	PCO+OA+HA (n=84)	F	P
AMH (ng/mL)	6.60±4.53	9.81±5.30	8.89±5.27	7.712	0.001^#
Age (years)	31.85±2.47	24.91±2.54	24.90±2.58	207.124	0.000^#
LH (mIU/mL)	8.93±5.78	13.16±6.91	11.51±5.98	7.930	0.000^#
LH/FSH	1.41±0.86	1.94±0.94	1.84±0.91	7.421	0.001^#
T(ng/mL)	0.53±0.15	1.02±0.28	1.02±0.29	121.996	0.000^#
BMI (kg·m^−2)	27.69±4.73	26.9±5.12	26.8±4.88	0.930	0.396
HOMA-IR	3.75±2.41	4.67±1.81	4.02±2.28	2.078	0.128
FSH (mIU/mL)	6.44±1.75	6.81±1.31	6.52±2.23	0.474	0.623
FPG (mmol/L)	5.50±1.23	5.86±1.01	5.61±1.06	1.261	0.286
FINS (mmol/L)	15.12±6.75	18.01±6.82	15.93±7.11	2.237	0.109
HbA1c (%)	5.775±1.05	6.16±1.46	5.84±1.25	0.698	0.500

Note: ^#P <0.01. SPSS were used to perform this statistical analysis. All data were tested for normality and homogeneity of variance. Normally distributed data are expressed as means ± standard deviations. Effects in three groups were analyzed by analysis of variance, and the Bonferroni test was performed as a post-hoc test to determine where the statistical differences existed.

Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; LH, luteinizing hormone; AMH, anti-mullerian hormone; HOMA-IR, Homeostatic model assessment insulin resistant; T, Total testosterone. FINS, Fasting insulin; FPG, Fasting plasma glucose. PCO, polycystic ovary; HA, hyperandrogenism; OA, oligomenorrhea.

Figure 2 Indicators of significant differences in different PCOS phenotypes. *P <0.05, ^#P <0.01 vs. PCO+OA.

Table 6 Correlation Analysis of AMH and Various Indexes

Indicators	AMH
	R	P
BMI (kg·m^−2)	−0.208	0.002^#
FINS (mmol/L)	0.265	0.000^#
LH (mIU/mL)	0.223	0.001^#
LH/FSH	0.311	0.000^#
FSH (mIU/mL)	−0.126	0.062
HOMA-IR	0.223	0.001^#
T (ng/mL)	0.356	0.000^#
Age (years)	−0.315	0.000^#
HbA1c (%)	−0.011	0.915
FPG (mmol/L)	−0.053	0.439

Note: ^#P <0.01. SPSS were used to perform this statistical analysis. Pearson correlation analysis was performed to study the correlation between AMH and age, obesity, IR, and other indicators of PCOS.

Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; LH, luteinizing hormone; AMH, anti-mullerian hormone; HOMA-IR, Homeostatic model assessment insulin resistant; T, Total testosterone; FINS, Fasting insulin; FPG, Fasting plasma glucose.

Table 7 Multiple Linear Regression Analysis of AMH Influencing Factors

Model	Nonstandardized Coefficients		Standardized Coefficients Beta	T	P
	B	Std.Error
Constant	−2.9592.999	7.718		−0.383	0.702
T (ng/mL)	6.578	2.431	0.437	2.707	0.007^#
LH/FSH	2.017	0.728	0.362	2.769	0.006^#
FINS (mmol/L)	0.195	0.091	0.265	2.148	0.033*
BMI (kg·m^−2)	−0.179	0.064	−0.171	−2.790	0.006^#
LH (mIU/mL)	−0.173	0.105	−0.211	−1.643	0.102
Age (years)	0.225	0.192	0.189	1.170	0.243
HOMA-IR	−0.081	0.270	−0.036	−0.301	0.764

Note: *P <0.05, ^#P <0.01. SPSS were used to perform this statistical analysis. Multiple linear regression analysis was performed to determine the factors influencing AMH.

Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; LH, luteinizing hormone; HOMA-IR, Homeostatic model assessment insulin resistant; T, Total testosterone. FINS, Fasting insulin.

Table 8 Correlation Analysis of AMH and Various Indexes in Different PCOS Phenotypes

indicators	AMH(OA+HA/PCO+OA+HA) n=118		AMH(PCO+OA)n=102
	R	P	R	P
Age (years)	−0.259	0.000^#	−0.212	0.033*
BMI (kg·m^−2)	−0.227	0.001^#	−0.213	0.031*
HbA1c (%)	−0.055	0.613	−0.167	0.257
FPG (mmol/L)	0.148	0.040*	0.002	0.987
FINS (mmol/L)	0.204	0.004^#	0.343	0.000^#
HOMA-IR	0.245	0.001^#	0.234	0.018*
LH (mIU/mL)	0.143	0.046*	0.287	0.004^#
FSH (mIU/mL)	−0.121	0.092	−0.180	0.071
LH/FSH	0.231	0.001^#	0.410	0.000^#
T (ng/mL)	0.347	0.000^#	0.217	0.029*

Note: *P <0.05, ^#P <0.01. SPSS were used to perform this statistical analysis. Pearson correlation analysis was performed to study the correlation between AMH and various indexes in different PCOS phenotypes.

Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; LH, luteinizing hormone; AMH, anti-mullerian hormone; HOMA-IR, Homeostatic model assessment insulin resistant; T, Total testosterone. FINS, Fasting insulin; FPG, Fasting plasma glucose. PCO, polycystic ovary; HA, hyperandrogenism; OA, oligomenorrhea.

Table 9 Multiple Linear Regression Analysis of AMH Influencing Factors in Different PCOS Phenotypes

Model		Nonstandardized Coefficients		Standardized Coefficients	T	P
		B	Std.Error	Beta
OA+HA/PCO+OA+HA (n=118)	Constant	3.514	9.026		0.389	0.697
	Age (years)	0.265	0.204	0.165	1.298	0.196
	BMI (kg·m^−2)	−0.218	0.073	−0.201	−2.985	0.003^#
	FPG (mmol/L)	−1.145	0.892	−0.215	−1.283	0.201
	FINS (mmol/L)	−0.209	0.255	−0.269	−0.820	0.413
	HOMA-IR	1.542	1.009	0.586	1.528	0.128
	LH (mIU/mL)	−0.183	0.108	−0.218	−1.703	0.090
	LH/FSH	1.743	0.782	0.292	2.230	0.027*
	T (ng/mL)	6.878	2.024	0.434	3.398	0.001^#
PCO+OA (n=102)	Constant	1.241	28.423		0.044	0.965
	Age (years)	0.059	0.712	0.032	0.082	0.934
	BMI (kg·m^−2)	−0.137	0.088	−0.143	−1.568	0.120
	FINS (mmol/L)	0.200	0.116	0.298	1.723	0.088
	HOMA-IR	−0.072	0.311	−0.038	−0.232	0.817
	LH(mIU/mL)	−0.184	0.166	−0.235	−1.109	0.270
	LH/FSH	2.782	1.158	0.525	2.402	0.018*
	T (ng/mL)	4.304	11.803	0.142	0.365	0.716
The dependent variable: AMH

Note: *P <0.05, ^#P <0.01. SPSS were used to perform this statistical analysis. Multiple linear regression analysis was performed to determine the factors influencing AMH in different PCOS phenotypes.

Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; LH, luteinizing hormone; AMH, anti-mullerian hormone; HOMA-IR, Homeostatic model assessment insulin resistant; T, Total testosterone; FINS, Fasting insulin; FPG, Fasting plasma glucose; PCO, polycystic ovary; HA, hyperandrogenism; OA, oligomenorrhea.