经直肠超声对特发性中枢性性早熟的诊断价值

Stablishment and evaluation of a diagnostic model for idiopathic central precocious puberty with transretal ultrasoundgraphy

目的探讨经直肠子宫、卵巢超声对特发性中枢性性早熟女童的诊断价值。方法纳入2015年1月至2018年12月于河北医科大学第二医院就诊的6~9岁乳房发育Tanner BⅡ期的692例女童的回顾性队列建立诊断模型。根据GnRH激发试验结果,将受试者分为特发性中枢性性早熟(idiopathic central precocious puberty,ICPP)组394例和单纯乳房发育(premature thelarche,PT)组298例,纳入经直肠子宫、卵巢超声参数:子宫体积、平均卵巢体积、最大卵泡直径和子宫内膜厚度等,建立二元Logistic诊断方程,通过受试者工作曲线(ROC)计算截断值(cut-off)。另纳入来自两家医院的117例女童的前瞻性队列验证诊断模型。结果两组间子宫体积、平均卵巢体积、最大卵巢体积、≥4 mm卵泡数、最大卵泡直径、子宫内膜厚度、子宫/宫颈前后径差异存在统计学意义(均P<0.05),初诊年龄、BMI和子宫/宫颈长径差异无统计学意义(P>0.05)。通过二元Logistic回归分析,拟合的联合预测方程:Logit(P)=-5.075+0.498×子宫体积+0.943×平均卵巢体积+2.912×最大卵泡直径+4.356×子宫内膜厚度,ROC曲线AUC为0.895,灵敏度为81.73%,特异性为82.89%。117例验证病例与GnRH激发试验结果完全一致有96例。结论应用联合诊断方程可以有效预测6~9岁女童特发性中枢性性早熟。

Objective To establish idiopathic central precocious puberty diagnostic model with transretalultrasound graphy as variables and to evaluate its diagnostic efficacy.MethodsA retrospective epidemiologicalstudy was performed in 692 girls with Tanner breast development stageⅡand age 6~9 years. Clinical data wereobtained from the Department of Pediatrics,The Second Hospital of Hebei Medical University from January 2015 toDecember 2018. According to Gn RH stimulation test results,subjects were divided into 394 patients in idiopathiccentral precocious puberty(ICPP)group and 298 patients in premature thelarche(PT)group. The parameters be-tween the two groups were compared. Receiver operating characteristic(ROC)curve was used to analyze the valueof pelvic ultrasound in the prediction of idiopathic central precocious puberty,and binary Logistic regression analy-sis was conducted to establish a multi-index joint diagnosis model.ResultsThe difference of uterine volume,av-erage ovarian volume,maximum ovarian volume,≥ 4 mm follicle number,maximum follicular diameter,endome-trial thickness,and uterine anteroposterior diameter/cervical anteroposterior diameter between the two groupswas statistically significant(P < 0.05),but the difference of initial diagnosis age,BMI,and longitudinal uterinediameter/longitudinal cervical diameter was not statistically significant(P > 0.05). Through binary Logistic regres-sion analysis,the diagnostic model was successfully established,followed by:Y =-5.075 + 0.498 × uterine vol-ume + 0.943 × average ovarian volume + 2.912 × maximum follicular diameter + 4.356 × endometrial thickness,ROC curve AUC 0.895,sensitivity 81.73%,specificity 82.89%. In the 117 cases,96 were identical with consis-tent diagnosis and follow-up.ConclusionThe diagnostic model of idiopathic central precocious puberty success-fully established by pelvic ultrasound,which has high clinical value in the diagnosis of the idiopathic central preco-cious puberty of girls aged 6 to 9 years old.