体质量指数对中枢性性早熟女童GnRH激发试验结果的影响

Effect of body mass index on GnRH stimulation test for girls with central precocious puberty

目的探讨体质量指数(BMI)对特发性中枢性性早熟(ICPP)女童,促性腺激素释放激素(GnRH)激发试验中,促黄体生成素(LH)峰值和FSH的影响,为临床诊断中枢性性早熟LH峰值提供科学依据。方法选取2018年1月至2019年8月于台州市立医院进行GnRH激发试验诊断中枢性性早熟的96例女童为研究对象,按照BMI指数Z值将患儿分为正常组、超重组、肥胖组三组,分别为37例、33例、26例,比较三组患儿的LH及促卵泡生成素(FSH)基础值、LH及FSH峰值水平和峰值LH/FSH。结果正常组、超重组和肥胖组儿童LH基础值(分别为1.58±0.24mIU/mL、0.96±0.23mIU/mL、0.51±0.12mIU/mL)和FSH基础值(分别为4.47±0.65mIU/mL、3.29±0.62mIU/mL、2.48±0.53mIU/mL)逐渐下降,组间两两比较,差异均具有统计学意义(t=5.30~12.80,P<0.05),LH峰值(分别为12.41±2.29mIU/mL、9.13±2.03mIU/mL、8.22±1.55mIU/mL)和峰值LH/FSH比值(分别为0.96±0.21、0.76±0.34、0.71±0.29)超重组和肥胖组患儿均低于正常体重组(t=2.99~8.10,P<0.05),而超重组和肥胖组差异无统计学意义(t=0.59~1.89,P>0.05);FSH峰值在各组间均无统计学差异(均P>0.05)。结论体质量指数与女童GnRH激发试验中性激素水平密切相关,BMI越高,LH基础值、LH峰值、峰值LH/FSH越低,临床诊断时应该加以重视。

Objective To explore the effect of body mass index(BMI) on the luteinizing hormone(LH) peak and follicle-stimulating hormone(FSH) in the gonadotropin-releasing hormone(GnRH) stimulation test in girls with idiopathic central precocity puberty(ICPP), so as to provide a scientific basis for the clinical diagnosis of LH peak for ICPP.Methods From January 2018 to August 2019, 96 girls with ICPP and diagnosed by GnRH stimulation test in Taizhou Municipal Hospital were selected as subjects. According to the Z score of BMI, the children were divided into normal group(n=37), overweight group(n=33) and obese group(n=26). The baseline levels of LH, FSH, and the peak levels of LH, FSH and LH/FSH were compared among the three groups of children.Results Basal values of LH and FSH in the normal group(1.58±0.24 mIU/mL and 4.47±0.65 mIU/mL, respectively), overweight group(0.96±0.23 mIU/mL and 3.29±0.62 mIU/mL, respectively) and obese group(0.51±0.12 mIU/mL and 2.48±0.53 mIU/mL, respectively) decreased gradually, and differences between any two groups were statistically significant(t=5.30~12.80, all P<0.05). The peak levels of LH and LH/FSH in the overweight group(9.13±2.03 mIU/mL and 0.76±0.34, respectively) and obese group(8.22±1.55 mIU/mL and 0.71±0.29, respectively) were all significantly lower than those in the normal group(12.41±2.29 mIU/mL and 0.96±0.21, respectively), the differences were statistically significant(t=2.99~8.10, all P<0.05), but no significant difference was found between the overweight group and obese group(t=0.59~1.89, P>0.05). And there was no significant difference in the peak value of FSH among the three groups(all P>0.05).Conclusion Body mass index is closely related to sex hormone levels in GnRH stimulation test for girls. The higher the body mass index, the lower the LH base value, LH peak value and LH/FSH peak value, which should be taken seriously in diagnosis of ICPP in girls.