最近的方法学建议建议使用“三步法”,\“由基于日历的计数组成,尿排卵测试,和血清血液取样,用于识别细微的月经紊乱(SMD)。然而,使用3步法并不总是可行的,因此,基于日历的计数和排尿排卵测试的要求较低的组合,也就是说,两步法,可能是一个可行的选择。
目的:研究SMD检测的2步和3步方法之间的一致性。
方法:月经周期(MC,59名运动员中的98)采用2步和3步方法进行了评估。常规长度MC(即,≥21和≤35d)被归类为无SMD(黄体相长度≥10d,黄体中期孕酮浓度≥16nmol·L-1,并且正在排卵)或具有SMD(例如,短黄体期[<10d],黄体期不足[黄体中期孕酮浓度<16nmol·L-1],或无排卵)。使用McNemar检验和Cohenkappa(κ)评估方法一致性。
结果:在方法之间观察到实质上的一致性(κ=.72;95%CI,.53-.91),但是两步法没有检测到所有带有SMD的MC,导致系统偏差的证据(χ2=5.14;P=0.023)。两步法检测到61.1%的MC具有SMD([51.4,70.8]),正如使用三步法验证的那样,并正确识别了100%没有SMD的MC。
结论:使用两步法分类为受到干扰的MC可以被认为是SMD的有效证据。然而,没有SMD的MC不能明确确认他们的缺席,由于通过两步法证明检测不足。
Recent methodological recommendations suggest the use of the \"3-step method,\" consisting of calendar-based counting, urinary ovulation testing, and serum blood sampling, for the identification of subtle menstrual disturbances (SMDs). However, the use of the 3-step method is not always feasible, so a less demanding combination of calendar-based counting and urinary ovulation testing, that is, the 2-step method, may be a viable alternative.
OBJECTIVE: To investigate the agreement between the 2- and 3-step methods for the detection of SMDs.
METHODS: Menstrual cycles (MCs, 98) of 59 athletes were assessed using the 2- and 3-step methods. Regular-length MCs (ie, ≥21 and ≤35 d) were classified as either having no SMD (luteal phase length ≥10 d, midluteal progesterone concentration ≥16 nmol·L-1, and being ovulatory) or having an SMD (eg, short luteal phase [<10 d], inadequate luteal phase [midluteal progesterone concentration <16 nmol·L-1], or being anovulatory). Method agreement was assessed using the McNemar test and Cohen kappa (κ).
RESULTS: Substantial agreement was observed between methods (κ = .72; 95% CI, .53-.91), but the 2-step method did not detect all MCs with an SMD, resulting in evidence of systematic bias (χ2 = 5.14; P = .023). The 2-step method detected 61.1% of MCs that had an SMD ([51.4, 70.8]), as verified using the 3-step method, and correctly identified 100% of MCs without an SMD.
CONCLUSIONS: MCs classified as being disturbed using the 2-step method could be considered valid evidence of SMDs. However, MCs classified without SMDs do not definitively confirm their absence, due to the proven underdetection via the 2-step method.