单时相GnRH激发试验对不同体重指数女童中枢性性早熟诊断价值的研究

Value of single-phase gonadotropin-releasing hormone stimulation test in diagnosis of central precocious puberty in girls with different levels of body mass index

目的 探讨单时相促性腺激素释放激素(gonadotropin-releasing hormone,GnRH)激发试验对不同体重指数(body mass index,BMI)女童中枢性性早熟(central precocious puberty,CPP)的诊断价值。方法 回顾性分析2017年1月—2023年8月在郑州大学第三附属医院就诊的7.5岁前出现乳房发育的760例女童数据。根据GnRH激发试验结果和临床表现综合诊断,分为CPP组(n=297)和非CPP组(n=463)。再根据体重指数(body mass index,BMI)分为正常体重组(n=540)、超重组(n=116)及肥胖组(n=104)。采用受试者操作特征曲线分析单时相GnRH激发试验对不同BMI女童CPP的诊断价值。结果 GnRH激发后30 min黄体生成素(luteinizing hormone,LH)/卵泡刺激素诊断CPP的曲线下面积为0.985,高于0、60、90 min LH/卵泡刺激素的曲线下面积(P<0.05)。30 min与60 minLH诊断价值相当(P>0.05)。30 min LH与BMI及BMI-Z值呈负相关(P<0.05)。30 min LH在正常体重、超重、肥胖女童中诊断CPP的曲线下面积分别为0.952、0.965、0.954 (P<0.05)。结论 30 min GnRH激发试验对不同BMI女童CPP均有较好的诊断价值,有望替代传统的GnRH激发试验,但应注意BMI对LH水平的影响。

Objective To investigate the value of single-phase gonadotropin releasing hormone(GnRH)stimulation test in the diagnosis of central precocious puberty(CPP)in girls with different levels of body mass index(BMI).Methods A retrospective analysis was performed for the data of 760 girls with breast development before 7.5 years of age who attended the Third Affiliated Hospital of Zhengzhou University from January 2017 to August 2023.According to the results of GnRH stimulation test and clinical manifestations,they were divided into a CPP group(297 girls)and a non-CPP group(463 girls).According to the values of BMI,the girls were divided into a normal weight group(540 girls),an overweight group(116 girls),and an obese group(104 girls).The receiver operating characteristic(ROC)curve was used to investigate the value of single-phase GnRH stimulation test in the diagnosis of CPP in girls with different levels of BMI.Results Luteinizing hormone(LH)/follicle-stimulating hormone at 30 minutes after GnRH stimulation had an area under the curve(AUC)of 0.985 in the diagnosis of CPP,which was higher than the AUC at 0,60,and 90 minutes(P<0.05).LH at 30 minutes had a similar diagnostic value to LH at 60 minutes(P>0.05).LH at 30 minutes was negatively correlated with BMI and BMI-Z value(P<0.05).The AUC for diagnosing CPP in normal weight,overweight,and obese girls at 30 minutes LH was 0.952,0.965,and 0.954,respectively(P<0.05).Conclusions The 30-minute GnRH stimulation test has a good value in the diagnosis of CPP in girls with different levels of BMI and is expected to replace the traditional GnRH stimulation test,but the influence of BMI on LH level should be taken seriously.