血清抗苗勒管激素和抑制素B在中枢性性早熟和快进展型早发育女童诊断中的价值

Value of serum AMH and INHB in the diagnosis of central precocious puberty and early and fast puberty girls

目的探讨血清抗苗勒管激素(anti-mullerian hormone,AMH)和抑制素B(inhibin-b,INHB)在中枢性性早熟(central precocious puberty,CPP)和快进展型早发育(early and fast puberty,EFP)女童中诊断的意义。方法回顾性收集2020年10月至2022年12月在江西省儿童医院内分泌与遗传代谢科就诊的CPP、EFP、单纯乳房发育(premature thelarche,PT)、未发育健康女童资料423例。收集患儿年龄、身高、体重、性发育情况,性激素、AMH、INHB水平和子宫、卵巢体积等临床资料。比较CPP组与非CPP组(PT组和健康组)数据,使用受试者工作特征曲线(receiver operator characteristic,ROC)的方法判断AMH、INHB在预测CPP女童的诊断价值;比较EFP组、CPP组和健康组数据使用ROC的方法判断AMH、INHB是否可用于EFP女童早期预警,并用Spearman相关性分析分析各指标的相关性。结果CPP组血清AMH、INHB水平高于PT组,而EFP组血清INHB水平高于PT组。INHB诊断CPP的ROC曲线下面积为0.815(P<0.001),敏感度和特异度分别是83.0%和62.7%,而AMH诊断CPP的ROC曲线下面积为0.576(P=0.019)。AMH与卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)峰值、FSH峰值水平呈负相关。INHB早期预警EFP的ROC曲线下面积为0.896(P<0.001),敏感度和特异度分别是90.7%和77.6%;子宫体积(Volume of uterus,UV)早期预警EFP的ROC曲线下面积为0.944(P<0.001),敏感度和特异度分别是81.4%和92.3%;INHB联合UV早期预警EFP的ROC曲线下面积为0.964(P<0.001),对应的敏感度和特异度分别是93.8%和87.4%。在EFP女童中INHB与UV、LH基础值、FSH基础值和LH基础值/FSH基础值水平呈正相关。结论INHB对CPP女童具有诊断价值;AMH水平可作为区别中枢性性早熟和乳房早发育的潜在指标;血清INHB水平联合UV检测对临床上早期预警EFP女童有意义。

Objective To investigate the role of serum anti-mullerian hormone(AMH)and inhibin-B(INHB)in(central precocious puberty,CPP)and rapidly-progressive puberty(early and fast puberty,EFP).Methods A total of 423 healthy girls with central precocious puberty,early and fast puberty,premature thelarche or being undeveloped who were treated in the Department of Endocrinology and Genetics and Metabolism of Jiangxi Children's Hospital from October 2020 to December 2022 were retrospectively collected.Clinical data,including age,height,weight,sexual development,levels of sex hormones,AMH,and INHB,and uterine and ovarian volume,were collected.The data of CPP group and non-CPP group(PT group and healthy group)were compared,and the diagnostic value of AMH and INHB in predicting CPP girls was determined by receiver operating characteristic curve(ROC)method.The data of EFP group,CPP group and healthy group were compared using ROC method to determine whether AMH and INHB could be used for early warning of EFP girls,and Spearman correlation analysis was used to analyze the correlation among the indexes.Results The CPP group had higher serum AMH and INHB levels than the PT group,while the EFP group had higher serum INHB levels than the PT group.The area under the ROC curve for INHB in the diagnosis of CPP was 0.815(P<0.001),with sensitivity and specificity being 83.0%and 62.7%,respectively,while the area under the ROC curve for AMH in the diagnosis of CPP was 0.576(P=0.019).AMH was negatively correlated with levels of FSH,LH peak,and FSH peak.The area under the ROC curve for early warning EFP by INHB was 0.896(P<0.001),with sensitivity and specificity being 90.7%and 77.6%,respectively.The area under the ROC curve of volume of uterus for early warning EFP was 0.944(P<0.001),with sensitivity and specificity being 81.4%and 92.3%,respectively.The area under the ROC curve of INHB combined with UV for early warning EFP was 0.964(P<0.001),with corresponding sensitivity and specificity being 93.8%and 87.4%,respectively.In EFP,INHB was positively correlated with UV,basal LH,basal FSH,and basal LH/basal FSH levels.Conclusion This study confirms the diagnostic value of INHB for CPP girls.This study indicates that AMH levels can be used as a potential indicator to distinguish between CPP and PT.The combination of INHB level with UV detection is significant for early warning EFP girls in clinical practice.