GnRHa激发试验对性早熟的诊断价值探讨

Gonadotrophin-releasing hormone agonist stimulation test in evaluation of precocious puberty

目的 探讨GnRH类似物 (GnRHa)曲普瑞林 (triptorelin)激发试验对于性早熟的诊断价值。方法 将因乳房发育提前而就诊的 95例女孩 (均于就诊时行 0、30和 6 0minGnRHa激发试验 )分为 3组 :真性性早熟(CPP)组 5 0例、单纯性乳房早发育 (PT)组 32例、外周性性早熟 (PPP)组 13例。以 33例健康的青春前期女孩作为对照。比较各组血清促卵泡激素 (FSH)、促黄体生成激素 (LH)激发值和基值、FSH和LH的最大反应 (ΔFSH和ΔLH)及峰值之比 (峰LH/FSH ,免疫化学发光法测定 )。绘制诊断CPP的受试者工作特性曲线 ,确定具有较高诊断灵敏度和特异度的峰LH和峰LH/FSH的截断值。结果 PPP、PT、CPP和对照组的FSH基值以及LH基值均有明显的重迭。PPP组 3个时相的血清FSH及LH浓度无差异。PT、CPP组 3个时相的血清FSH及LH浓度均有显著差异 (P =0 0 0 )。PT组ΔFSH (8 76± 3 74 )IU/L显著高于ΔLH(2 5 7± 1 5 6 )IU/L(P =0 0 0 )。CPP组ΔLH(2 3 2 3± 19 16 )IU/L显著高于ΔFSH(10 6 0± 4 79)IU/L(P =0 0 0 )。PT组和CPP组的ΔFSH无差异 ,CPP组ΔLH和峰LH/FSH(1 6 6± 1 2 6 )显著高于PT组 (0 2 8± 0 11) (P =0 0 0 )。以LH峰值≥5 0 5IU/L为前提 ,诊断CPP的灵敏度和特异度分别为 98 0 %和 90 6 %。

Objective To evaluate the gonadotrophin releasing hormone agonist (GnRha), triptorelin stimulation test in assessing the precocious purberty. Methods Ninety five girls with premature thelarche who received GnRha stimulation test at 0, 30, 60 minutes when enrolled into the study, were divided into 3 groups: fifty with central precocious puberty (CPP group), thirty two simple premature thelarche (PT group) and thirteen peripheral precocious puberty (PPP group). Thirty three pre puberty girls were served as controls. Basal and stimulated serum FSH, LH, maximum FSH and LH increment (△FSH and △LH), ratio of peak LH to peak FSH (Peak LH/FSH) were measured by microparticle enzyme immunoassay. The operating characteristic curve of the receiver was made in order to obtain the highly sensitive and specific LH and FSH values. Results Basal FSH and LH values overlapped among the groups of PPP, PT, CPP and control. Serum levels of FSH and LH did not differ at 0, 30 and 60 minutes in PPP group. FSH and LH levels showed different concentrations at 0, 30 and 60 minutes in PT and CPP groups (P=0.00). △FSH level (8.76 ± 3.74) was higher than △LH (2.57 ± 1.56) in PT group (P=0.00). △LH level (23.23±19.36) was higher than △FSH (10.60±4.79) in CPP group (P=0.00). There was no difference in △FSH level between the PT and CPP groups, while △LH level and peak LH and FSH value in CPP group were significantly higher than those in PT group (P=0.00). Evaluated by peak LH level (≥5.05 IU/L), the sensitivity and specificity for diagnosing CPP were 98.0% and 90.6% respectively. Conclusion No pituitary response to GnRHa was found in PPP group. In respond to the stimulation, FSH was increased in PT Group and LH in CPP group. Basal LH is of little help, while GnRHa stimulation test is of value to the diagnosis of precocious puberty.