单次或重复曲普瑞林兴奋试验对特发性低促性腺激素性性腺功能减退症和体质性青春发育延迟鉴别诊断的作用

Clinical Values of Single or Repeated Triptorelin Stimulating Test in the Differential Diagnosis between Idiopathic Hypogonadotropic Hypogonadism and Constitutional Delayed Puberty

目的探讨单次和两次黄体生成素释放激素(LHRH)类似物(曲普瑞林)兴奋试验在鉴别诊断特发性低促性腺激素性性腺功能减退症(IHH)和体质性青春发育延迟(CDP)中的作用。方法对133例(IHH 86例、CDP47例)14岁后仍无青春发育表现的男性患者,进行曲普瑞林兴奋试验,并随访24～48个月直至确诊。其中,有9例IHH患者和13例CDP患者在初诊1年后再次进行曲普瑞林兴奋试验,以评价下丘脑-垂体-睾丸轴功能的动态变化。通过分析曲普瑞林兴奋试验黄体生成素(LH)峰值和诊断的相关性,以及两次兴奋试验中LH峰值的变化,评价单次和两次曲普瑞林兴奋试验在鉴别诊断IHH和CDP中的作用。结果单次曲普瑞林兴奋试验中,IHH患者LH峰值(1.9±1.2)U/L显著低于CDP患者LH峰值(13.7±8.3)U/L(P<0.01)。有75例(87.2%)IHH患者,LH峰值<4 U/L,而CDP患者只有2例(4.3%)LH峰值<4 U/L。以曲普瑞林兴奋试验LH峰值<4 U/L为IHH的标准,敏感性为87.2%、特异性为95.7%、阳性预测值为97.4%。随诊1年后第2次曲普瑞林兴奋试验中,9例IHH患者的LH峰值从(4.7±2.5)U/L升高到(5.1±3.3)U/L(P=0.78),而13例CDP患者的LH峰值从(10.7±3.3)U/L增加到(24.5±5.7)U/L(P<0.05)。结论单次曲普瑞林兴奋试验可对90.2%的IHH和CDP患者作出有效鉴别诊断。对部分诊断困难的青春发育延迟患者,间隔1年后行第2次曲普瑞林兴奋试验,有助于评价下丘脑-垂体-睾丸轴功能的动态变化,为IHH和CDP的确诊提供更多依据。

Objective To investigate the values of single or repeated luteinizing hormone（LH） releasing hormone analogue（triptorelin） stimulating test in the differential diagnosis between idiopathic hypogonadotropic hypogonadism（IHH） and constitutional delayed puberty（CDP）.Methods Male patients（n=133） without puberty onset after the age of 14 were recruited for triptorelin stimulating test and were followed up for 24-48 months until the diagnosis were confirmed： 86 were IHH and the other 47 were CDP.Repeated triptorelin stimulating tests were conducted in 9 IHH patients and 13 CDP patients one year after the first stimulating tests with an attempt to evaluate the dynamic change of hypothalamus-pituitary-testis axis function.The relationship between the final diagnosis and the peak LH value（LHmax）,and the changes of repeated LHmax were investigated.Results In the single triptorelin stimulating test,LHmax was（1.9±1.2）U/L in IHH group,which was significantly lower than that in CDP group [（13.7±8.3）U/L]（P〈0.01）;75 IHH patients（87.2%） had a LHmax lower than 4 U/L,while only 2 CDP patients（4.3%） had a LHmax lower than 4 U/L.When LHmax4U/L was used as a criteria for the diagnosis of IHH,the single triptorelin stimulating test had a sensitivity of 87.2%,a specificity of 95.7%,and a positive predictive value of 97.4%.The repeated triptorelin stimulating tests performed one year later showed that the LHmax in the 9 IHH patients increased from（4.7±2.5） U/L to（5.1±3.3）U/L（P=0.78）,while that in the 13 CDP patients increased from（10.7±3.3） U/L to（24.5±5.7） U/L（P〈0.05）.Conclusions A single triptorelin stimulating test is highly effective in differentiating IHH from CDP.For some patients without definitive diagnosis,a repeated triptorelin stimulating test performed one year later may provide more valuable information on the dynamic change of the hypothalamus-pituitary-testis axis function.