血清抗苗勒氏管激素和抑制素B预测女童缓慢进展中枢性性早熟的临床价值

The clinical value of serumanti-mullerian hormone and inhibin B in predicting girls with slowly progressive central precocious puberty

目的探讨血清抗苗勒氏管激素(AMH)和抑制素B(INHB)鉴别进展型中枢性性早熟(P-CPP)和缓慢进展型中枢性性早熟(SP-CPP)的临床价值。方法选取2018年3月至2019年3月成都市龙泉驿区妇幼保健院收治的126例疑似性早熟女童作为研究对象。经诊断72例CPP、54例乳房早发育(premature thelarche,PT)(PT组)。对72例CPP患儿进行无干预随访6个月,分为P-CPP组(n=45)和SP-CPP组(n=27),另选取30例健康女童设为对照组。比较四组女童血清AMH、INHB表达水平。绘制ROC曲线分析不同指标鉴别P-CPP和SP-CPP的价值。结果P-CPP组、SP-CPP组、PT组、对照组女童血清AMH浓度分别为(3.05±0.86)ng/ml、(5.39±0.12)ng/ml、(4.12±0.52)ng/ml、(2.12±0.35)ng/ml,INHB浓度分别为(62.35±5.68)pg/ml、(38.96±7.02)pg/ml、(25.39±2.85)pg/ml、(21.15±6.67)pg/ml。SP-CPP组女童血清AMH浓度高于其他三组,差异均具有统计学意义(均P<0.05)。SP-CPP组女童血清INHB浓度低于P-CPP组,但高于PT组和对照组,差异均具有统计学意义(均P<0.05)。ROC曲线分析结果显示,AMH和INHB鉴别P-CPP和SP-CPP的AUC分别为0.853和0.792,灵敏度分别为69.35%和75.33%,特异度分别为80.12%和79.68%。两者联合检测可将AUC提高至0.918,灵敏度和特异度分别提高至81.05%和89.41%。结论血清AMH和INHB水平有助于判断CPP进展,对鉴别P-CPP和SP-CPP有一定价值。

Objective To explore the clinical value of serum anti-mullerian hormone(AMH)and inhibin B in distinguishing progressive central precocious puberty(P-CPP)and slow progressive central precocious puberty(SP-CPP).Methods From March 2018 to March 2019,126 girls with suspected precocious puberty admitted to Longquanyi District of Chengdu Maternity and Child Health Care Hospital were selected,72 of whom were diagnosed as CPP and 54 diagnosed as premature thelarche(PT group).72 girls with CPP were followed up for 6 months without intervention,and were divided into P-CPP group(n=45)and SP-CPP group(n=27).Another 30 healthy girls were selected as the control group.The expression levels of AMH and inhibin B were compared among the four groups.ROC curve was drawn to analyze the value of identifying P-CPP and SP-CPP with different indexes.Results The serum AMH concentrations of P-CPP group,SP-CPP group,PT group and the control group were(3.05±0.86)ng/ml,(5.39±0.12)ng/ml,(4.12±0.52)ng/ml,(2.12±0.35)ng/ml respectively,the inhibin B concentrations were(62.35±5.68)pg/ml,(38.96±7.02)pg/ml,(25.39±2.85)pg/ml,(21.15±6.67)pg/ml respectively.The serum AMH concentration of SP-CPP group was higher than that of the other three groups(P<0.05).The serum inhibin B concentration of SP-CPP group was lower than that of P-CPP group,but higher than that of the PT group and the control group(P<0.05).ROC curve analysis showed that the AUC of P-CPP and SP-CPP identified by AMH and INHB were 0.853 and 0.792 respectively,with sensitivity of 69.35%and 75.33%,specificity of 80.12%and 79.68%respectively.The combination of the two methods can increase AUC to 0.918,sensitivity and specificity to 81.05%and 89.41%respectively.Conclusions Serum AMH and INHB levels are helpful to judge the progress of CPP and to distinguish P-CPP and SP-CPP.