基础黄体生成素水平对女童中枢性性腺启动状态的预测能力分析

The predictive power of basal luteinizing hormone level for central gonadal activation states in girls

目的探讨基础黄体生成素(LH)水平对女童中枢性性腺启动状态的预测能力。方法选取2015年2月至2022年8月于济宁医学院附属医院住院检查的8岁前出现第二性征发育,并完成促性腺激素释放激素类似物激发试验的343例女童,收集其一般临床资料、实验室及影像学检查结果,根据激发结果分为单纯性乳房早发育(PT)组(n=114)、部分性中枢性性早熟(CPP)组(n=118)和完全性CPP组(n=111)。Logistic回归分析PT和完全性CPP的独立影响因素,受试者工作特征(ROC)曲线分析独立影响因素对PT和完全性CPP的预测能力。结果PT、部分性CPP和完全性CPP组的基础LH水平分别为0.06(0.01,0.16)U/L、0.30(0.12,0.56)U/L、1.50(0.72,2.83)U/L,3组比较差异有统计学意义(H=164.74,P<0.01)。年龄、基础LH、雌二醇水平和子宫体积是PT的独立影响因素;基础LH、雌二醇水平和子宫体积是完全性CPP的独立影响因素。基础LH水平是PT和完全性CPP的最佳预测指标,AUC分别为0.874和0.878。基础LH水平预测PT的最佳切点为0.185 U/L(敏感度83.90%,特异度75.90%),预测完全性CPP的最佳切点为0.435 U/L(敏感度80.50%,特异度84.10%)。结论基础LH水平对女童中枢性性腺启动状态具有很好的预测能力,可以作为CPP的早期筛查指标。

Objective To investigate the predictive power of basal luteinizing hormone(LH)level for central gonadal activation states in girls.Methods A total of 343 girls who developed secondary sex characteristics before the age of 8 years old and were hospitalized in the Affiliated Hospital of Jining Medical University from February 2015 to August 2022 were included in this study.The general clinical data were collected and the gonadotropin-releasing hormone analogue(GnRHa)stimulation test was performed.Based on the peak of LH in the GnRHa stimulation test,these girls were categorized into three groups:premature thelarche(PT),partial central precocious puberty(CPP),and complete CPP.The Logistic regression was used to clarify the independent correlation factors of PT and complete CPP.Receiver operating characteristic(ROC)curve was applied to compare the predictive power of the independent factors for PT and complete CPP.Results Basal LH level showed significant differences between PT,partial CPP,and complete CPP groups with quartiles of 0.06(0.01,0.16)U/L,0.30(0.12,0.56)U/L,and 1.50(0.72,2.83)U/L,respectively.The difference between the three groups was meaningful in statistic(H=164.74,P<0.01).Age,basal LH,estradiol level,and uterine volume were independent influential factors of PT.Basal LH,estradiol level,and uterine volume were independent influential factors for complete CPP.Basal LH level was the best predictor for PT and complete CPP with AUCs of 0.874 and 0.878,respectively.The optimal cut-points of basal LH level for predicting PT and complete CPP were 0.185 U/L(sensitivity 83.90%,specificity 75.90%)and 0.435 U/L(sensitivity 80.50%,specificity 84.10%),respectively.Conclusion Basal LH level is a valuable predictor of central gonadal activation states in girls,and can be used as an early screening index for CPP.