摘要
目的探讨简化曲普瑞林(triptorelin)激发试验评估女童下丘脑-垂体-性腺轴(HPGA)启动的价值。方法生长发育异常女童108例(性早熟87例、矮小症13例和青春期预测终身高矮小8例)中,HPGA启动者79例,未启动者29例。所有患儿均行曲普瑞林激发试验。用免疫化学发光分析法检测促黄体生成素(LH)和卵泡刺激素(FSH)。结果 HPGA启动者和未启动者的LH峰值(PLH)分别为(20.24±15.39)和(2.56±1.03)IU/L,PLH/FSH峰值(PFSH)分别为(1.35±0.94)和(0.32±0.42)(P<0.01)。曲普瑞林激发试验40min LH(91/108例)、60min LH(107/108例)、PLH(90/108例)诊断HPGA启动的受试者工作特性曲线下面积分别为0.990、0.982和0.990;当Youden指数最大时,即40min LH、60min LH、PLH分别为≥4.09IU/L、≥4.04IU/L和≥4.22IU/L时,其诊断HPGA启动的灵敏度分别为93.9%、96.2%和96.9%,其对应的特异度均为100.0%;当40min和60min的LH≥4.22IU/L时,其诊断HPGA启动的灵敏度分别为90.9%和96.2%,其对应的特异度均为100.0%。当PLH/PFSH≥0.47时,其诊断HPGA启动的灵敏度和特异度分别为83.1%和96.0%。结论 1h的曲普瑞林激发试验为评估女童HPGA启动的可靠实验室指标;其40min或60min单次血促性腺激素诊断价值与促性腺激素峰值接近。
Objective To evaluate the clinical value of simplified triptorelin stimulation test in diagnosing the initiation of hypothalamic-pituitary-gonadal axis(HPGA) for girls. Methods A total of 108 girls with abnormal development(87 cases with precocious puberty, 13 cases with short stature, 8 cases with short stature of predicted adult height) was divided into two groups of A(79 cases with HPGA initiation) and B(29 cases without HPGA initiation). The triptorelin stimulation tests were performed in all children. Serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were examined by immunochemiluminometric assay(ICMA). Results Serum peak values of LH(PLH) were (20. 24±15.39) IU/L and (2.56±1.03) IU/L,and serum PLH/peak FSH(PFSH) were (1.35±0. 94) and (0. 32±0. 42) in groups of A and B, respectively(P〈0. 01). The area under the ROC of LH for diagnosing HPGA initiation was 0. 990 at 40 min,0. 982 at 60 min,and 0. 990 for PLH. When the maximum Youden indexes of ≥4. 09 IU/L,≥4.04 IU/L and ≥4. 22 IU/L were taken as the cutoff values for LH at 40 min, LH at 60 min and PLH, respectively, the sensitivities for diagnosing HPGA initiation were 93.9%, 96.2% and 96.9%, respectively, and the specificity was 100. 0% for all cases. Taking ≥4.22 IU/L as the cutoff value for LH at 40 min and at 60 min, the sensitivities for diagnosing HPGA initiation were 90. 9 % and 96.2 %, respectively, and the specificity was 100. 0% for all cases. When PLH/PFSH was ≥0. 47, the sensitivity for diagnosing HPGA initiation was 83. 1% and the specificity was 96.0%. Conclusion The simplified triptorelin stimulation test(one-hour method) is a reliable indicator for evaluating the initiation of HPGA in girls. The value of diagnosing HPGA initiation with one gonadotropin measurement obtained at 40 min or 60 min is similar to that obtained from HPGA.
出处
《江苏医药》
CAS
北大核心
2013年第9期1075-1078,共4页
Jiangsu Medical Journal