盆腔超声联合骨龄指数对女童性早熟的诊断价值

The diagnostic value of pelvic ultrasound combined with bone age index for precocious puber⁃ty in girls

目的:探讨盆腔超声联合骨龄指数(BAI)在女童性早熟(PP)诊断中的价值。方法:选取因乳房早发育来本院就诊的PP女童124例,根据促性腺激素释放激素(GnRH)激发试验结果,分为中枢性PP(CPP)组(61例)和单纯乳房早发育(PT)组(63例)。比较两组盆腔超声检查相关测量值及骨龄指数(BAI)。采用多因素Logistic回归分析法分析影响CPP诊断的因素,受试者工作特征(ROC)曲线分析盆腔超声检查相关测量值和BAI在女童CPP诊断中的价值。结果:CPP组宫体长径、宫体横径、宫体前后径、宫体体积、宫体与宫颈长径比值、宫体与宫颈前后径比值、卵巢体积、最大卵泡直径以及BAI均大于PT组(P<0.05)。宫体与宫颈长径比值和BAI为CPP诊断的独立影响因素(P<0.05)。宫体与宫颈长径比值、BAI及两者联合诊断CPP的ROC曲线下面积(AUC)分别为0.815(95%CI:0.738~0.892)、0.780(95%CI:0.695~0.865)、0.843(0.772~0.913),两者联合诊断CPP的AUC大于单独检测。结论:盆腔超声联合BAI对女童CPP的诊断价值较高。

Objective:To investigate the diagnostic value of pelvic ultrasound combined with bone age index(BAI)for girls with precocious puberty.Methods:A total of 124 girls with early breast development were enrolled in this study.According to the results of the gonadotropin-releasing hormone stimulation test,the participants were divided into two groups,including 61 cases of the central precocious puberty(CPP)group and 63 cases of the premature thelarche(PT)group.The measured values of pelvic ultrasound examination and BAI were compared between the two groups.Multivariate logistic regression analysis was conducted for exploring the factors that might affect the diagnosis of CPP.The receiver operating characteristic(ROC)curve was used to analyze the value of pelvic ultrasound combined with BAI in the diagnosis of CPP in girls.Results:Nine indexes including(1)length diameter of the uterine body,(2)transverse diameter of the uterine body,(3)anteroposterior diameter of the uterine body,(4)volume of the uterine body,(5)ratio of the length diameter of the uterine body to the cervix,(6)ratio of the anteroposterior diameter of the uterine body to the cervix,(7)volume of the ovary,(8)maximum diameter of the follicle,and(9)BAI were significantly higher in the CPP group than those in the PT group(P<0.05).The ratio of length diameter of the uterine body to the cervix and BAI were independent risk factors for the diagnosis of CPP(P<0.05).The area under curve(AUC)values of the ROC curves for the ratio of length diameter of the uterine body to the cervix,BAI,and the combination of the two were 0.815(95%CI:0.738–0.892),0.780(95%CI:0.695–0.865)and 0.843(95%CI:0.772–0.913),respectively.The diagnostic ability of the ratio of length diameter of the uterine body to the cervix combined with BAI was superior to the single detection of the ratio of length diameter of the uterine body to the cervix or BAI.Conclusion:Pelvic ultrasound combined with BAI has marvelous diagnostic value for CPP in girls.