晨血促黄体生成素联合胰岛素样生长因子1对儿童青春期启动的筛查效能

Efficacy of morning serum LH combined with IGF-1 on pubertal initiation in children

目的探索晨血促黄体生成素(LH)和胰岛素样生长因子(IGF-1)水平对青春期启动的筛查切值点及筛查效能,为合理开展GnRH刺激试验、促进儿童青春期系统管理提供依据。方法采用回顾调查的方法,选取2019年1月1日至2021年12月31日在武汉儿童医院儿童保健科体检、乳房发育在B2~B3期或睾丸体积在4.00~10.00 mL、同期在内分泌病房进行GnRH刺激试验的1724名8~13岁儿童为研究对象。采用彩色多普勒超声测定性腺容积,采用GnRH刺激试验判断儿童青春期启动状况,采用ROC曲线确定晨血LH、IGF-1筛查切值点,并进行信度和效度检验。结果男童睾丸容积(4.88±2.19)mL,性腺启动者检出率75.5%;女童卵巢容积(1.78±0.65)mL,性腺启动者检出率91.39%。GnRH刺激试验显示,男、女童LH峰值中位数为13.22,21.79 IU/L,LH/FSH峰值比中位数为2.13,1.87,青春期启动者597,864例。男、女童晨血LH对青春期启动的筛查切值点为0.23(Kappa=0.60)和0.22 IU/L(Kappa=0.66),IGF-1切值点为187.00(Kappa=0.45)和178.00 IU/L(Kappa=0.46)。男童晨血LH单项筛查、女童晨血LH与IGF-1串联筛查的灵敏度和特异度均较高,筛查效能较好(Kappa指数分别为0.60,0.64)。结论晨血LH、IGF-1是儿童青春期启动的良好预测指标,当男童晨血LH达0.23 IU/L、女童晨血LH达0.22 IU/L且IGF-1达178.00 IU/L时,应进行GnRH刺激试验明确青春期启动状况。

Objective To explore the screening cut-off point and screening efficacy of morning serum LH combined with IGF-1 levels on puberty initiation to provide the basis for developing the gnrh stimulation test reasonably and promoting the systematic management of children and adolescence.Methods A retrospective study was conducted to select 1724 children aged 8-13 years who took physical examination and were identified of breast development(between grade 2 and grade 3)or increased testicular volume(4.00-10.00 mL)in Child Health Department of Wuhan Children’s Hospital during January 1 st 2019 and December 31 th 2021,and gonadotropin releasing hormone(GnRH)stimulation test was performed in endocrinology department ward in the same period.Doppler ultrasound was used to determine gonadal volume,and GnRH stimulation test was conducted to determine the puberty initiation in children.The ROC curve was utilized to determine the screening cut-off points of morning serum LH and IGF-1 on puberty initiation,and the reliability and validity of the cut-off points were all tested.Results The testicular volume was(4.88±2.19)mL in boys,and 75.5%was classified as initiation of gonadal growth.Whereas the ovaries volume was(1.78±0.65)mL in girls,and 91.39%classified as initiation of gonadal growth.The results of the GnRH stimulation test showed that among boys and girls,the medians LH peak were 13.22 and 21.79 IU/L,and the median LH/FSH peak ratios were 2.13 and 1.87.As a result,597 boys and 864 girls were diagnosed as puberty initiation.Screening efficacy analysis indicated that the cut-off point of morning serum LH on puberty initiation were 0.23 IU/L in male(Kappa=0.60)and 0.22 IU/L in female(Kappa=0.66),and IGF-1 cut-off point were 187.00 IU/L in male(Kappa=0.45)and 178.00 IU/L in female(Kappa=0.46).High sensitivity and specificity and better screening efficacy(Kappa=0.60,0.64)on single-item screening of morning blood LH in boys and tandem screening of LH and IGF-1 in girls.Conclusion Morning serum LH and IGF-1 are good predictors on puberty initiation.GnRH stimulation test should be carried out to determine the puberty initiation when morning serum LH reaches 0.23 IU/L in boys,morning serum LH reaches 0.22 IU/L and IGF-1 reaches 178.00 IU/L in girls.