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目的探讨简化曲普瑞林(triptorelin)激发试验评估女童下丘脑-垂体-性腺轴(HPGA)启动的价值。方法生长发育异常女童108例(性早熟87例、矮小症13例和青春期预测终身高矮小8例)中,HPGA启动者79例,未启动者29例。所有患儿均行曲普瑞林激发试验。用免疫化学发光分析法检测促黄体生成素(LH)和卵泡刺激素(FSH)。结果 HPGA启动者和未启动者的LH峰值(PLH)分别为(20.24±15.39)和(2.56±1.03)IU/L,PLH/FSH峰值(PFSH)分别为(1.35±0.94)和(0.32±0.42)(P<0.01)。曲普瑞林激发试验40min LH(91/108例)、60min LH(107/108例)、PLH(90/108例)诊断HPGA启动的受试者工作特性曲线下面积分别为0.990、0.982和0.990;当Youden指数最大时,即40min LH、60min LH、PLH分别为≥4.09IU/L、≥4.04IU/L和≥4.22IU/L时,其诊断HPGA启动的灵敏度分别为93.9%、96.2%和96.9%,其对应的特异度均为100.0%;当40min和60min的LH≥4.22IU/L时,其诊断HPGA启动的灵敏度分别为90.9%和96.2%,其对应的特异度均为100.0%。当PLH/PFSH≥0.47时,其诊断HPGA启动的灵敏度和特异度分别为83.1%和96.0%。结论 1h的曲普瑞林激发试验为评估女童HPGA启动的可靠实验室指标;其40min或60min单次血促性腺激素诊断价值与促性腺激素峰值接近。
Objective To investigate the value of simplified triptorelin provocation test to assess the initiation of hypothalamic-pituitary-gonad axis (HPGA) in girls. Methods 108 cases of abnormal growth and development of girls (87 cases of precocious puberty, 13 cases of short stature and puberty prediction of the height of 8 cases), HPGA promoter in 79 cases, 29 cases did not start. All children underwent triptorelin challenge. Immuno chemiluminescence assay was used to detect luteinizing hormone (LH) and follicle stimulating hormone (FSH). Results The LH peak (PLH) of HPGA promoter and non-promoter were (20.24 ± 15.39) and (2.56 ± 1.03) IU / L, respectively, and the PLH / FSH peak values were 1.35 ± 0.94 and 0.32 ± 0.42 ) (P <0.01). In the triptorelin challenge test, the areas under the performance curve of HPGA-initiated subjects for 40 min LH (91/108), 60 min LH (107/108), PLH (90/108) diagnoses were 0.990, 0.982 and 0.990, respectively ; When the Youden index was the largest, the sensitivity of HPGA for diagnosis was 93.9%, 96.2% when the Youmin index was 40min LH, 60min LH and PLH were ≥4.09IU / L, ≥4.04IU / L and ≥4.22IU / L, respectively 96.9%, respectively. The corresponding specificity was 100.0%. When LH≥4.22IU / L at 40min and 60min, the sensitivities of diagnosing HPGA were 90.9% and 96.2% respectively, and the corresponding specificity was 100.0%. When the PLH / PFSH≥0.47, the sensitivity and specificity of diagnosis of HPGA were 83.1% and 96.0% respectively. Conclusion The triptorelin challenge test at 1h was a reliable laboratory test for evaluating HPGA initiation in girls. The diagnostic value of single gonadotropin at 40min or 60min was close to that of gonadotropin.