血清LH、IGF-ⅠSDS、IGF-bp3诊断女童快速进展型中枢性性早熟的价值研究

A study on the value of serum LH,IGF-ⅠSDS and IGF-bp3 in diagnosing rapidly progressive central precocious puberty in girls

目的分析血清黄体生成素(LH)、胰岛素样生长因子Ⅰ标准差积分(IGF-ⅠSDS)及胰岛素样生长因子结合蛋白3(IGF-bp3)在早期识别快速进展型中枢性性早熟(RP-CPP)和缓慢进展型中枢性性早熟(SP-CPP)患儿中的有效性,为临床进一步提高对女童RP-CPP的诊疗水平提供参考资料。方法回顾性分析2021年4月至2023年6月西安交通大学附属儿童医院收治的120例中枢性性早熟(CPP)女童患儿的临床资料,将其纳入研究组,按照线性生长或骨龄成熟加速等条件,将其分为RP-CPP组(71例),SP-CPP组(49例);纳入同期在院体检的青春期发育正常女童64例为对照组。比较不同人群LH、IGF-ⅠSDS及IGF-bp3水平的变化情况,采用多元Logistic回归分析影响儿童RP-CPP的相关危险因素,采用受试者工作特征(ROC)曲线评估LH、IGF-ⅠSDS及IGF-bp3预测RP-CPP的效能。结果研究组的LH、IGF-ⅠSDS、IGF-bp3及骨龄均明显高于对照组,经比较差异均有统计学意义(t值分别为26.256、47.930、20.390、14.008,P<0.05)。LH、IGF-ⅠSDS、IGF-bp3与骨龄均呈正相关(r值分别为0.435、0.502、0.397,P<0.05)。RP-CPP组的LH、IGF-ⅠSDS水平均明显高于SP-CPP组,经比较差异均有统计学意义(t值分别为7.867、33.943,P<0.05),但RP-CPP组与SP-CPP组的IGF-bp3水平比较,差异无统计学意义(P>0.05)。经多元Logistic回归分析显示,LH[OR(95%CI):1.962(1.172~3.285)]、IGF-ⅠSDS[OR(95%CI):1.707(1.142~2.552)]及IGF-bp3[OR(95%CI):2.314(1.221~4.384)]均是影响RP-CPP发生的危险因素(P<0.01)。经ROC曲线分析显示,LH、IGF-ⅠSDS及IGF-bp3单独预测RP-CPP的曲线下面积(AUC)从高到低依次为0.799、0.762、0.714,三者联合预测RP-CPP的AUC为0.864,其明显高于各指标单独预测的结果(P<0.001)。结论CPP女童的血清LH、IGF-ⅠSDS及IGF-bp3水平均存在异常,通过检测患儿的上述指标变化,可有效地预测病情的进展,LH、IGF-ⅠSDS及IGF-bp3水平较高者发生RP-CPP的风险相对较大。

Objective To analyze the effectiveness of serum luteinizing hormone(LH),insulin-like growth factorⅠstandard deviation score(IGF-ⅠSDS)and insulin-like growth factor binding protein 3(IGF-bp3)in early identification of children with rapidly progressive central precocious puberty(RP-CPP)and slowly progressive central precocious puberty(SP-CPP),so as to provide reference data for further improving the diagnosis and treatment of RP-CPP in girls in clinic.Methods The clinical data of 120 girls with central precocious puberty(CPP)admitted to The Affiliated Children's Hospital of Xi′an Jiaotong University from April 2021 to June 2023 were retrospectively analyzed and included in the study group.According to the conditions of linear growth or accelerated bone age maturation,they were divided into RP-CPP group(71 cases)and SP-CPP group(49 cases);64 girls with normal puberty development who underwent physical examination in the hospital during the same period were included as the control group.The changes of LH,IGF-ⅠSDS and IGF-bp3 levels in different groups were compared.Multivariate Logistic regression was used to analyze the risk factors affecting RP-CPP in children.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of LH,IGF-ⅠSDS and IGF-bp3 in predicting RP-CPP.Results The LH,IGF-ⅠSDS,IGF-bp3,and bone age in the study group were higher than those in the control group,and the differences were statistically significant(t=26.256,47.930,20.390,and 14.008,respectively,P<0.05).LH,IGF-ⅠSDS,and IGF-bp3 were positively correlated with bone age(r=0.435,0.502,and 0.397,respectively,P<0.05).The levels of LH and IGF-ⅠSDS in the RP-CPP group were significantly higher than those in the SP-CPP group,and the differences were statistically significant(t=7.867 and 33.943,respectively,P<0.05),but there was no difference in the level of IGF-bp3 between the RP-CPP group and the SP-CPP group(P>0.05).Multiple Logistic regression analysis showed that LH[OR(95%CI):1.962(1.172-3.285)],IGF-ⅠSDS[OR(95%CI):1.707(1.142-2.552)]and IGF-bp3[OR(95%CI):2.314(1.221-4.384)]were risk factors for the occurrence of RP-CPP(P<0.01).ROC curve analysis showed that the area under the curve(AUC)of LH,IGF-ⅠSDS and IGF-bp3 for predicting RP-CPP were 0.799,0.762 and 0.714 respectively,and the AUC of the three indicators combined for predicting RP-CPP was 0.864,which was significantly higher than the results of each indicator alone(P<0.001).Conclusion The serum LH,IGF-ⅠSDS and IGF-bp3 levels of CPP girls are abnormal.By detecting the changes in the above indicators in children,the progression of the disease can be effectively predicted.Those with higher levels of LH,IGF-ⅠSDS and IGF-bp3 have a relatively greater risk of developing RP-CPP.