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目的探讨血清促性腺激素在性早熟女童诊断中的价值。方法分析在该院内分泌科确诊为中枢性性早熟(CPP,n=91)和部分性性早熟(PICPP,n=46)女童血清黄体生成素(LH)和促卵泡激素(FSH)基础值及促性腺激素释放激素(GnRH)激发试验后峰值,采用受试者工作特征(ROC)曲线分析FSH、LH、LH/FSH曲线下面积(AUC)、诊断CPP的阈值及所对应的灵敏度和特异度。结果 CPP组患儿血清基础LH、FSH水平及LH/FSH比值均高于PICPP组(P<0.01),诊断CPP的AUC分别为0.825、0.723和0.781,当血清LH基础值为0.35IU/L时,灵敏度为76.9%,特异度为76.1%;当诊断阈值为1.52IU/L时,诊断特异度为100.0%。CPP组患儿血清LH峰值、LH峰值/FSH峰值均高于PICC组(P<0.01),诊断CPP的AUC分别为0.981和0.944,而两组患儿血清FSH峰值差异无统计学意义(P>0.05)。当LH峰值为5.61IU/L时,诊断CPP的灵敏度为94.6%、特异度为100.0%,或当LH峰值/FSH峰值为0.62时,其诊断CPP特异度100.0%。结论 LH基础值超过1.52IU/L的患儿,结合临床表现可明确诊断CPP,无须行GnRH激发试验。GnRH激发试验LH峰值超过5.61IU/L时,可诊断为CPP。
Objective To investigate the value of serum gonadotropin in the diagnosis of precocious girls. Methods The basic values of serum LH and FSH in girls with central precocious puberty (CPP, n = 91) and partially precocious puberty (PICPP, n = 46) The peak value of GnRH stimulation test was used to analyze the area under the curve of FSH, LH and LH / FSH (ROC curve), the threshold value of CPP and the corresponding sensitivity and specificity . Results The serum levels of LH, FSH and LH / FSH in CPP group were significantly higher than those in PICPP group (P <0.01). The AUC of diagnosis CPP were 0.825,0.723 and 0.781 respectively. When the serum LH was 0.35 IU / L , The sensitivity was 76.9% and the specificity was 76.1%. When the diagnostic threshold was 1.52 IU / L, the diagnostic specificity was 100.0%. The serum LH and LH peak / FSH peak value in CPP group were higher than those in PICC group (P <0.01), and the AUC of CPP diagnosis were 0.981 and 0.944, respectively. There was no significant difference in the serum FSH peak value between the two groups (P> 0.05). When the LH peak was 5.61 IU / L, the sensitivity of the diagnosis of CPP was 94.6% with a specificity of 100.0%, or 100.0% with a diagnosis of CPP specificity when the LH peak / FSH peak was 0.62. Conclusions Children with a basal LH level of 1.52 IU / L can definitely diagnose CPP in combination with clinical manifestations without GnRH provocation test. GnRH excitation test LH peak value of more than 5.61IU / L, can be diagnosed as CPP.