血清AMH、基础LH联合诊断女童中枢性性早熟的临床价值及二者与盆腔超声表现的关系分析

The Clinical value of combined serum AMH and basal LH in diagnosis of central precocious puberty in girls and their relationship with pelvic ultrasound findings

目的探讨血清抗苗勒氏管激素(anti⁃Müllerian hormone,AMH)、基础促黄体生成素(luteinizing hormone,LH)联合诊断女童中枢性性早熟(central precocious puberty,CPP)的临床价值及二者与盆腔超声表现的关系。方法选取2021年1~12月期间于北京京煤集团总医院收治的62例CPP女童为CPP组,选取同期58例健康女童为对照组。所有女童均进行盆腔超声检查,并比较两组血清AMH、基础LH水平。采用Pearson法分析血清AMH、基础LH水平与盆腔超声参数的相关性。采用多因素Logistic回归分析法明确影响CPP女童诊断的危险因素,并采用受试者工作特征(receiver operating characteristic,ROC)曲线分析血清AMH、基础LH及盆腔超声相关参数单独及联合应用对CPP女童诊断的预测价值。结果CPP组子宫横径、长径、前后径及体积,卵巢横径、长径、前后径及体积,内膜厚度,最大卵泡直径及直径>4 mm卵泡数均高于对照组(P<0.05);Pearson相关性分析显示,血清AMH、LH基础值与子宫体积、卵巢体积、内膜厚度、最大卵泡直径均呈正相关(P<0.001),与直径>4mm卵泡数无相关性(P>0.05);CPP组骨龄、FSH基础值、E_(2)、AMH、LH基础值水平均高于对照组(P<0.05);多因素Logistic回归分析显示,血清AMH、LH基础值高水平,子宫体积、卵巢体积大,子宫内膜厚均是影响女童发生CPP的危险因素(P<0.05)。ROC分析结果显示:血清AMH、LH基础值、超声诊断预测女童发生CPP的AUC值(95%CI)分别为0.673(0.582⁃0.756)、0.689(0.598⁃0.770)、0.832(0.752⁃0.894),二者联合预测效能高于各项单独检测(Z=2.722、2.092,P<0.05)。结论CPP女童血清AMH、基础LH水平升高,血清AMH、LH基础值高水平是影响CPP发生的独立危险因素,二者联合检测对于CPP女童具有更高的诊断价值,血清AMH、LH基础值水平与盆腔超声指标中子宫体积、卵巢体积、内膜厚度均呈正相关。

Objective To investigate the clinical value of serum anti⁃Müllerian hormone(AMH)and basal luteinizing hormone(LH)in the diagnosis of central precocious puberty(CPP)in girls and the relationship between them and pelvic ultrasonography.Methods A total of 62 CPP girls(CPP group)and 58 healthy girls(control group)were selected in Beijing Jingmei Group General Hospital from January 2021 to December 2021.All girls underwent pelvic ultrasound examination,checked and compared serum AMH and basal LH levels between the two groups.Pearson method was used to analyze the correlation between serum AMH,basal LH levels and pelvic ultrasound parameters.Multiple Logistic regression analysis was used to determine the risk factors affecting the diagnosis of CPP girls.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum AMH,basal LH and pelvic ultrasound parameters in the diagnosis of CPP in girls alone and in combination.Results The transverse diameter,long diameter,anteroposterior diameter and volume of uterus,transverse diameter,long diameter,anteroposterior diameter and volume of ovary,endometrial thickness,maximum follicle diameter and the number of follicles with diameter>4 mm in CPP group were higher than those in control group(P<0.05).Pearson correlation analysis showed that serum AMH and LH basal values were positively correlated with uterine volume,ovarian volume,endometrial thickness,maximum follicle diameter(P<0.001),no correlation with number of follicles with diameter>4 mm(P>0.05).Bone age,FSH base value,E_(2),AMH,LH base value in CPP group were higher than those in control group(P<0.05).Multivariate Logistic regression analysis showed that high serum AMH and LH base values,large uterine and ovarian volume,and thick endometrial were all risk factors for CPP in girls(P<0.05).ROC analysis results showed that:the AUC values(95%CI)of serum AMH,LH,ultrasound diagnosis and combined prediction of CPP in girls were 0.673(0.582⁃0.756),0.689(0.598⁃0.770)and 0.832(0.752⁃0.894),respectively.The prediction efficiency of the combined test was higher than that of each single test(Z=2.722,2.092,P<0.05).Conclusion The elevated serum levels of AMH and basal LH in girls with CPP,and the high levels of serum AMH and basal LH values are independent risk factors affecting the occurrence of CPP,and the combined detection of the two has higher diagnostic value for girls with CPP.The basal serum levels of AMH and LH are positively correlated with uterine volume,ovarian volume and endometrial thickness in pelvic ultrasound.