生殖系统超声检查联合血清抗米勒管激素对中枢性性早熟与单纯性乳房早发育女童诊断价值的研究

Study on the diagnostic value of reproductive system ultrasound combined with serum anti-Müllerian hormone in girls with central precocious puberty and premature thelarche

目的 研究生殖系统超声检查联合血清抗米勒管激素(AMH)对中枢性性早熟(CPP)与单纯性乳房早发育(PT)女童的诊断价值。方法 选取惠州市第一人民医院2019年2月至2022年2月收治的100例性早熟女童作为研究对象,根据诊断分为观察组(诊断为CPP)与对照组(诊断为PT),各50例。收集两组基线资料及临床特征,对两组患儿进行卵巢、子宫超声检查,抽取其空腹血测定AMH水平,并通过单独及联合诊断对CPP与PT患儿进行诊断鉴别。结果 观察组骨龄高于对照组,乳房TannerⅢ期占比显著高于对照组(P<0.05)。观察组子宫、卵巢的长径及体积和最大卵泡直径均超过对照组(P<0.05);两组患儿卵巢及子宫横径、前后径无显著差异(P>0.05)。观察组血清AMH水平(2.65±1.32)ng/mL低于对照组的(3.78±1.44)ng/mL(P<0.05)。当血清AMH水平、子宫长径、子宫体积、卵巢长径、卵巢体积及最大卵泡直径作为诊断指标时,其曲线下面积(AUC)分别可达0.718、0.695、0.769、0.707、0.727及0.770,联合诊断价值最佳(AUC=0.904),对应特异度、灵敏度为94.0%、90.0%。结论 生殖系统卵巢、子宫的超声检查联合血清AMH水平检测对CPP与PT患儿的鉴别具有较高的诊断价值,临床上可考虑作为CPP诊断的参考。

Objective To study the diagnostic value of reproductive system ultrasound combined with serum anti-Müllerian hormone(AMH)in girls with central precocious puberty(CPP)and premature thelarche(PT).Methods Girls with precocious puberty admitted to Huizhou First People's Hospital from February 2019 to February 2022 were selected and divided into observation group(diagnosed as CPP)and control group(diagnosed as PT),with 50 cases in each group.The basic data and clinical characteristics of the two groups were collected,the ovarian and uterine ultrasound examinations were performed on the two groups of children,and the fasting serum of the two groups of children was taken to determine the level of AMH,and the diagnosis and differentiation of CPP and PT children were performed through separate and combined diagnostic analysis.Results The bone age of the observation group was higher than that of the control group,and the breast TannerⅢwas significantly higher than that of the control group(P<0.05).The length and volume of the uterus and ovary,and the diameter of the largest follicle in the observation group were higher than that of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the transverse and anteroposterior diameters of ovary and uterus between the two groups(P>0.05).The serum AMH level in the observation group[(2.65±1.32)ng/mL]was lower than that in the control group[(3.78±1.44)ng/mL](P<0.05).When serum AMH level,uterine length,uterine volume,ovarian length,ovarian volume and maximum follicle diameter were used as diagnostic indicators,the area under the curve(AUC)could reach 0.718,0.695,0.769,0.707,0.727 and 0.770 respectively.The combined diagnostic value was the best(AUC=0.904),and the corresponding specificity and sensitivity were 94.0%and 90.0%.Conclusions For the differentiation of CPP and PT in children,ultrasound examination of the reproductive system,ovaries,and uterus combined with serum AMH level detection have high diagnostic value,and can be considered as a reference for the diagnosis of CPP in clinical practice.