基础血清黄体生成素水平对女孩中枢性性早熟诊断价值的探讨

Diagnostic value of baseline serum luteinizing hormone level for central precocious puberty in girls

目的评价基础血清黄体生成素(LH)对女性中枢性性早熟(CPP)的诊断价值。方法以279例女性性早熟患儿为研究对象,其中CPP 175例、单纯乳房早发育(PT)104例,均行体格生长评价、骨龄测定以及基础LH、卵泡刺激素(FSH)检测和性激素激发试验等。采用受试者工作曲线(ROC)分析基础LH、FSH及其峰值对诊断CPP的意义,并分析基础LH与LH峰值的相关性。结果 CPP组的骨龄,基础LH、FSH,以及LH和FSH峰值,LH/FSH峰值之比均较PT组升高(P<0.01)。以基础LH和LH峰值诊断效果较好。基础LH对骨龄7.0~9.0岁,9.0~11.0岁,>11.0岁3个CPP亚组的诊断价值以>11.0岁组的曲线下面积(AUC)最大。基础LH在0.45 IU/L时Youden指数最大,灵敏度为0.667、特异度为0.8;LH峰值在9.935 IU/L时Youden指数最大,灵敏度为0.748、特异度为1。基础LH与LH峰值成正相关(r=0.440、P<0.01)。结论基础LH可作为诊断CPP的初筛指标,在不同骨龄阶段均有一定的诊断价值,并可作为疗效监测指标。

Objective To evaluate the diagnostic value of baseline serum luteinizing hormone （LH） level for central precocious puberty （CPP） in girls. Methods A total of 279 girls with precocious puberty were subjected to assessment of growth and development, bone age determination, baseline LH test, and follicle-stimulating hormone （FSH） test, gonadotropin-releasing hormone stimulation test, and other related examinations. Of the 279 patients, 175 were diagnosed with CPP and 104 with premature thelarche （PT）. The receiver operating characteristic （ROC） curve was used to evaluate the diagnostic value of baseline LH and FSH levels and their peak levels for CPP, and the correlation between the baseline LH level and the peak LH level was analyzed. Results The CPP group had significantly higher bone age, baseline LH and FSH levels, peak LH and FSH levels, and ratio of peak LH level to peak FSH level than the PT group （P〈0.01）. The ROC curve proved that baseline LH level and peak LH level had good diagnostic values for CPP. Among the three bone age subgroups in the CPP group （7.0-9.0 years, 9.0-11.0 years, and 〉1 1.0 years）, baseline LH level showed the best diagnostic value in the 〉11.0 years subgroup, with the largest area under the ROC curve. At a baseline LH level of 0.45 IU/L, the Youden index reached the peak value, and the sensitivity and specificity were 66.7% and 80% respectively, for the diagnosis of CPE At a peak LH level of 9.935 IU/L, the Youden index reached the peak value, and the sensitivity and specificity were 74.8% and 100% respectively, for the diagnosis of CPE The baseline LH level was positively correlated with the peak LH level （r=0.440, P〈0.01）. Conclusions Baseline LH level can be used as an primary screening index for the diagnosis of CPP. It has a certain diagnostic value for CPP at different bone ages, and may be used as a monitoring index during the treatment and follow-up.