特发性中枢性性早熟与单纯性乳房早发育的鉴别诊断

Differential diagnosis of Idiopathic central precocious puberty and simple early breast development

目的:探究特发性中枢性性早熟(ICPP)与单纯性乳房早发育(IPT)的鉴别诊断。方法:选取2012年1月至2014年1月期间我院接收治疗的乳房增大的女童108例,根据2010年《性早熟诊疗指南(试行)》诊断标准将108例患者分为ICPP组和IPT组。其中ICPP组有58例患儿,IPT组有50例患儿。采用免疫化学发光法测定两组患儿的雌二醇(E2)、卵泡刺激素(FSH)、血清黄体生成素(LH)水平,进行促性腺激素释放激素(GnRH)激发试验,对比两组患儿的LH峰值结果,LH峰值/FSH峰值、受试者工作特性曲线(ROC)面积,并根据最大约登指数确定各指标最佳诊断切点值。结果:ICPP组患儿的LH基础值、LH峰值、LH峰值/FSH峰值、E2值分别为0.33 m IU/m L、12.84 m IU/m L、0.98、26.72 pg/m L,IPT组患儿的LH基础值、LH峰值、LH峰值/FSH峰值、E2值分别为0.07m IU/m L、2.54 m IU/m L、0.21、21.13 pg/m L。上述各项比较两组间差异均具有统计学意义(P<0.05)。当LH峰值>5.07 m IU/m L、LH峰值/FSH峰值>0.59时,鉴别IPT和ICPP的敏感性为98.17%,特异性为100%。结论:在GnRH激发试验中,LH峰值>5.07 m IU/m L、LH峰值/FSH峰值>0.59是鉴别诊断IPT和ICPP的最佳时间。

Objectives：To explore the differential diagnosis of idiopathic central precocious puberty （ICPP）and simple early breast development （IPT）.Methods：108 cases of girls with breast enlargement treated in our hospital from January 2012 to January 2014 were selected.According to the 2010 Precocious Treatment Guide-lines （Trial）diagnostic criteria ICPP,108 patients were divided into ICPP group （58 cases）and IPT group （50 ca-ses）.Immunochemiluminescence method was used to detect estradiol （E2 ）,follicle stimulating hormone （FSH） and serum luteinizing hormone （LH）levels of the two groups.Gonadotropin -releasing hormone （GnRH）stimula-tion test was done to compare LH peak value,LH peak /FSH peak,the receiver operating characteristic curve （ROC）area of the two groups to determine the best diagnostic cut -off point of each index value.Results：LH baseline,LH peak,LH peak /FSH peak and E2 values of ICPP group were 0.33 mIU /mL,12.84 mIU /mL,0.98 and 26.72 pg/mL,respectively.LH baseline,LH peak,LH peak /FSH peak and E2 values of IPT group were re-spectively 0.07mIU /mL,2.54 mIU /mL,0.21 and 21.13 pg /mL.The differences of the indexes above be-tween the two groups were statistically significant （P 〈0.05）.When the LH peak 〉5.07 mIU /mL,LH peak /FSH peak 〉0.59,the sensitivity to identify IPT and ICPP was 98.17% and the specificity was 100%.Conclusions：In Gn-RH stimulation test,the time that LH peak 〉5.07 mIU /mL and LH peak /FSH peak 〉0.59 is the best time for the differential diagnosis of IPT and ICPP.