GnRHa激发试验与GnRH激发试验诊断价值的对比研究

Comparative study of GnRHa stimulation test and GnRH stimulation test

目的比较特发性中枢性性早熟女童GnRHa激发试验与GnRH激发试验的诊断价值。方法选取2016年1月至2018年6月因乳房提前发育(<8岁)而就诊的6~10岁女童108例,随机分为GnRH激发试验组和GnRHa激发试验组。综合患儿骨龄、子宫及卵巢超声及6个月的随访的确诊结果,比较两种激发试验的诊断价值。结果本研究共纳入108例患儿,行GnRHa激发试验40例(37%),其中确诊特发性中枢性性早熟25例(63%);行GnRH激发试验68例(63%),其中确诊特发性中枢性性早熟的30例(44%)。GnRHa激发试验组与GnRH激发试验组比较:LH峰值分别为11.33(6.81,15.79)、7.89(5.35,14.21),两组数据差异无统计学意义(U=1078.50,P=0.07);FSH峰值分别为15.68(10.18,20.06)、17.26(13.34,21.42),两组数据差异无统计学意义(U=1617.50,P=0.10)。而LH峰值/FSH峰值分别为0.86(0.37,1.17)、0.52(0.31,0.83),差异有统计学意义(U=953.00,P=0.01)。GnRH激发试验诊断ICPP的灵敏度为90.91%(81.10%~100.72%),特异度为94.29%(86.60%~101.98%),总符合率为92.65%(86.44%~98.85%),约登指数为0.85(0.72~0.98)。GnRHa激发试验诊断ICPP的灵敏度为95.24%(86.13%~104.35%),特异度为73.68%(53.88%~93.48%),总符合率为85.00%(73.93%~96.07%),约登指数0.69(0.47~0.91)。结论对于女童特发性中枢性性早熟的诊断,GnRHa激发试验较GnRH激发试验灵敏度偏高,特异度及约登指数均偏低,不建议应用GnRHa替代GnRH进行激发试验。

Objective To compare the results of GnRHa stimulation test and GnRH stimulation test in girls with Idiopathic central precocious puberty. Methods The girls aged 6-10 who were diagnosed with early breast development(<8 years old) from January 2016 to June 2018 were randomly divided into GnRHa stimulation test group and GnRH stimulation test group according to clinical manifestations, auxiliary examinations and follow-up.The difference in the results of the stimulation test between the two groups was compared. Results A total of 108 girls were enrolled in this study, and 40(37%) of the GnRHa stimulation tests were performed.Among them, 25(63%) patients with idiopathic central precocious puberty had the confirmed diagnosis, and the GnRH stimulation test was performed.Of the 68(63%) patients, 30(44%) had idiopathic central precocious puberty.The peaks of LH in the GnRHa challenge test group and the GnRH challenge test group were 11.33(6.81, 15.79) and 7.89(5.35, 14.21), and the FSH peaks were 15.68(10.18, 20.06) and 17.26(13.34, 21.42), showing no significant differences (U=1078.50, P=0.07;U=1617.50, P=0.10). The peak values of LH/FSH were 0.86(0.37, 1.17) and 0.52(0.31, 0.83), respectively, and there was a statistical difference(U=953.00, P=0.01). GnRH challenge test showed the ICPP sensitivity of 90.91%(81.10%-100.72%), specificity of 94.29%(86.60%-101.98%), total coincidence rate of 92.65%(86.44 %-98.85%), Yoden index of 0.85( 0.72%-0.98%). Sensitivity of the GnRHa challenge test showed the ICPP diagnosis rate of 95.24%(86.13%-104.35%), specificity of 73.68%(53.88%-93.48%), total coincidence rate of 85.00%(73.93%-96.07%), Yoden index of 0.69(0.47-0.91). Conclusion For the diagnosis of idiopathic central precocious puberty in girls, the GnRHa challenge test is more sensitive than the GnRH challenge test, and the specificity and the Yoden index are both low.Therefore, routine use of GnRHa stimulation test as the replacement of GnRH stimulation test is not recommended.