促性腺激素在诊断女童性早熟中的临床价值

Clinical value of serum gonadotropin levels in the diagnosis of precocious puberty in girls

目的探讨血清促性腺激素在性早熟女童诊断中的价值。方法分析在该院内分泌科确诊为中枢性性早熟(CPP,n=91)和部分性性早熟(PICPP,n=46)女童血清黄体生成素(LH)和促卵泡激素(FSH)基础值及促性腺激素释放激素(GnRH)激发试验后峰值,采用受试者工作特征(ROC)曲线分析FSH、LH、LH/FSH曲线下面积(AUC)、诊断CPP的阈值及所对应的灵敏度和特异度。结果 CPP组患儿血清基础LH、FSH水平及LH/FSH比值均高于PICPP组(P<0.01),诊断CPP的AUC分别为0.825、0.723和0.781,当血清LH基础值为0.35IU/L时,灵敏度为76.9%,特异度为76.1%;当诊断阈值为1.52IU/L时,诊断特异度为100.0%。CPP组患儿血清LH峰值、LH峰值/FSH峰值均高于PICC组(P<0.01),诊断CPP的AUC分别为0.981和0.944,而两组患儿血清FSH峰值差异无统计学意义(P>0.05)。当LH峰值为5.61IU/L时,诊断CPP的灵敏度为94.6%、特异度为100.0%,或当LH峰值/FSH峰值为0.62时,其诊断CPP特异度100.0%。结论 LH基础值超过1.52IU/L的患儿,结合临床表现可明确诊断CPP,无须行GnRH激发试验。GnRH激发试验LH峰值超过5.61IU/L时,可诊断为CPP。

Objective To study the clinical value of serum gonadotropin levels in the diagnosis of precocious puberty in girls. Methods A total of 137 girls with central precocious puberty（CPP,n=91） and partial central precocious puberty（PICPP,n=46） were enrolled from department of endocrinology in Shenzhen childrenrs hospital. The baseline values and the peak values in stimulating hormone（GnRH） stimulation test of luteinizing hormone（LH）, follicle stimulating hormone（FSH） and LH/FSH ratio were compared between the two groups. The receiver operating characteristic（ROC）curve was used to analyze the accuracy of LH, FSH and LH/FSH ratio in the diagnosis of CPP. Results The baseline of serum LH,FSH and LH/FSH ratio in CPP group were significantly higher than those in PICPP（P〈0.01）. The area under curve（AUC）of LH,FSH and LH/FSH ratios among 137 girls were 0. 825,0. 723 and 0. 781 respectively. When the baseline of LH was 0. 35 IU/L, the sensitivity was 76.9%, the specificity was 76. 1% . When diagnostic threshold was 1.52 IU/L,the specificity was 100.0%. The peak of serum LH and LH/FSH ratio in CPP group were significantly higher than those in PICPP（P〈0.01）. The AUC of LH and LH/FSH were 0. 981 and 0. 944 respectively. The peak of FSH has no significant difference between CPP and PICPP（P〉0.05）. When the peak of LH was 5.61 IU/L,the sensitivity was 94.6% ,the specificity was 100.0%. When diagnostic threshold of peak LH/FSH ratio were 0.62, the specificity was 100.0%. Conclusion When the basal serum LH level is higher than 1.52 IU/L,the diagnosis of CPP can be confirmed in combination with clinical manifestation,GnRH stimulation test is unnecessary. When the peak LH stimulated by GnRH were 5.61 IU/L, the diagnosis of CPP can be confirmed.