超声联合血清性激素检查对女童性早熟的鉴别诊断价值

The differential diagnosis value of ultrasound combined with serum sex hormone examination in precocious puberty in girls

目的分析超声联合血清性激素检查对女童中枢性性早熟(CPP)与外周性性早熟(PPP)、不完全性性早熟(IPP)的鉴别诊断价值。方法选取2019年1月—2020年9月四川省绵阳市妇幼保健院超声科诊断性早熟女童231例,根据促性腺激素释放激素(GnRH)激发试验结果分为CPP组109例、PPP组62例、IPP组60例。检测并比较3组女童超声检查指标(子宫体积、单侧卵巢体积、单侧卵巢直径≥0.4 cm卵泡个数、单侧乳腺厚度)及基础血清性激素水平[促黄体生成激素(LH)、卵泡刺激素(FSH)、雌二醇(E_(2))]。ROC曲线评估超声联合血清性激素检查对女童CPP与PPP、IPP的鉴别诊断价值。结果子宫体积、单侧卵巢体积、单侧卵巢直径≥0.4 cm卵泡个数比较,CPP组>PPP组>IPP组,而单侧乳腺厚度比较,PPP组<CPP组<IPP组,差异均有统计学意义(F/P=583.391、508.993、1797.990、141.858,P均<0.001)。血清基础LH、FSH、E_(2)水平比较,CPP组>IPP组>PPP组,差异均有统计学意义(F/P=157.913、598.470、475.269,P均<0.001)。ROC曲线分析显示,子宫体积、单侧卵巢体积、单侧卵巢直径≥0.4 cm卵泡个数、单侧乳腺厚度联合血清基础LH、FSH、E_(2)鉴别诊断女童CPP与IPP的AUC为0.964(95%CI 0.937~0.991),敏感度为0.936,特异度为0.900,约登指数为0.836,均高于单一指标检测;7项指标联合鉴别诊断女童CPP与PPP的AUC为0.994(95%CI 0.988~1.000),敏感度为0.945,特异度为0.984,约登指数为0.929,均高于单一指标检测。结论CPP女童子宫体积、单侧卵巢体积、单侧卵巢直径≥0.4 cm卵泡个数及血清基础LH、FSH、E_(2)水平均高于PPP、IPP,上述指标联合检查有助于提高女童CPP与PPP、IPP的鉴别诊断价值。

Objective To analyze the value of ultrasound combined with serum sex hormone examination in the differential diagnosis of central precocious puberty(CPP),peripheral precocious puberty(PPP)and incomplete sexual precocious puberty(IPP)in girls.Methods Selected from January 2019 to September 2020 in the Department of Ultrasound,Mianyang Maternal and Child Health Hospital,Sichuan Province to diagnose precocious puberty girls.According to the gonadotropin-releasing hormone(GnRH)challenge test results,they were divided into CPP group,109 cases,PPP group,62 cases,and IPP group,60 cases.Ultrasound indexes(uterine volume,unilateral ovarian volume,number of follicles with unilateral ovarian diameter≥0.4 cm,unilateral breast thickness)and basal serum sex hormone levels[luteinizing hormone(LH),follicle stimulation hormone(FSH),estradiol(E_(2))].The ROC curve was used to evaluate the value of ultrasound combined with serum sex hormone examination in the differential diagnosis of CPP,PPP and IPP in girls.Results Uterine volume,unilateral ovarian volume,and number of follicles with a diameter of unilateral ovary≥0.4 cm,CPP group>PPP group>IPP group,and unilateral breast thickness comparison,PPP group<CPP group<IPP group,the differences were statistically significant Significance(F/P=583.391,508.993,1797.990,141.858,all P<0.001).Comparison of serum basal LH,FSH and E_(2) levels,CPP group>IPP group>PPP group,the differences were statistically significant(F/P=157.913,598.470,475.269,all P<0.001).ROC curve analysis showed that the AUC of uterine volume,unilateral ovarian volume,number of follicles with unilateral ovarian diameter≥0.4 cm,unilateral breast thickness combined with serum basal LH,FSH,and E_(2) in the differential diagnosis of CPP and IPP in girls was 0.964(95%CI 0.937-0.991),the sensitivity was 0.936,the specificity was 0.900,and the Youden index was 0.836,all of which were higher than single index detection.The AUC of 7-item combined differential diagnosis of CPP and PPP in girls was 0.994(95%CI 0.988-1.000),the sensitivity was 0.945,the specificity was 0.984,and the Youden index was 0.929,all of which were higher than single-index detection.Conclusion Uterine volume,unilateral ovarian volume,number of follicles with unilateral ovarian diameter≥0.4 cm,and serum basal LH,FSH,and E_(2) levels in girls with CPP were all higher than those of PPP and IPP,the combination of above indicators has differential diagnostic value.