基础LH独立和联合超声指标对女童中枢性性早熟的诊断价值

The Diagnostic Value of Basic LH Independent and Combined Ultrasound Index for Central Precocious Puberty in Girls

摘要: 目的：探讨多项基础指标在女童中枢性性早熟(central precocious puberty, CPP)筛查中的独立诊断价值及联合应用时的增益价值。方法：回顾性分析78名初诊性早熟女童的身体质量指数(body mass index, BMI)、骨密度(bone mineral density, BMD)、骨龄、脑垂体MR、盆腔B超以及基础黄体生成素(bascal luteinizing hormone, B-LH)、卵泡刺激素(bascal follicle-stimulating hormone, B-FSH)、胰岛素样生长因子1 (insulin-like growth factor 1, IGF-1)、胰岛素样生长因子结合蛋白3 (insulin-like growth factor-binding protein 3, IGF-BP3)、睾酮(testosterone, TES)、雌二醇(estradiol, E2)、性激素结合蛋白(sex hormone- binding protein, SHBG)、垂体泌乳素(pituitary prolactin, PRL)、人绒毛膜促性腺激素(human chorion Gonadotropin, HCG)等资料。根据垂体促性腺激素释放激素(gonadotropin-releasing hormone, GnRH)激发试验结果分为CPP组(病例组)及对照组，分析两组间各指标水平的差异、以及单独或联合应用时的诊断效能。结果：在78例女童中GnRH激发试验阳性56例(56/78, 71.79%)，阴性22例(22/78, 28.21%)。骨龄与实际年龄的差值、LH、FSH、SHBG、IGF-1、卵巢长径、卵巢体积和子宫体积在病例组和对照组之间的差异具有统计学意义(P值均 < 0.05)，其中独立诊断价值中，实验室检查指标基础LH诊断价值最高(LH > 0.43时，诊断敏感性75.00%，特异性95.50%，AUC = 0.89，约登指数0.70)；影像学检查指标卵巢长径诊断价值最佳(AUC = 0.73，约登指数0.39，当>25.00 mm时，诊断敏感性67.92%，特异性71.43%)。联合LH + 卵巢长径两项指标计算其诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为87.50%、77.8%、85.14%、92.45%和66.67%。结论：单项指标筛查CPP女童时，LH筛查价值最高；影像学筛查中以超声测量卵巢直径诊断价值最佳；二者联合可更好地筛查出CPP。

Abstract: Object: To study the value of multiple basic indicators in the screening of girls with central preco-cious puberty (CPP) and the value of their combined application. Methods: Retrospective analysis medical records of 78 girls who was newly diagnosed precocious puberty, including body mass in-dex (BMI), bone mineral density (BMD), bone age, pituitary MR, pelvic ultrasound and bascal lute-inizing hormone (B-LH), bascal follicle-stimulating hormone (B-FSH), Insulin-like growth factor 1 (IGF-1), insulin-like growth factor-binding protein 3 (IGF-BP3), testosterone (TES), estradiol (E2), sex hormone-binding protein (SHBG), pituitary prolactin (PRL), human chorion Gonadotropin (HCG) and other information. According to the results of pituitary gonadotropin-releasing hormone (GnRH) stimulation test, they were divided into central precocious puberty group (case group) and control group. The differences of each index level between the two groups and the diagnostic efficacy of sin-gle or combined application were analyzed. Results: GnRH stimulation test was positive in 56 cases (56/78, 71.79%) and negative in 22 cases (22/78, 28.21%). The differences between bone age and chronological age, LH, FSH, SHBG, IGF-1, ovarian length diameter, ovarian volume and uterine vol-ume between the case group and the control group were statistically significant (all P < 0.05). Among these indicators, LH was the most valuable index in the diagnostic (LH > 0.43, with the sen-sitivity was 75.0%, specificity was 95.5%, AUC was 0.89, Yoden index was 0.70). Ovarian length had the best diagnostic value (AUC = 0.73, Youden index 0.39, diagnostic sensitivity 67.92% and speci-ficity 71.43% when >25.00 mm). Combined diagnosis of the two indexes calculated that the diag-nostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 87.50%, 77.8%, 85.14%, 92.45%, and 66.67%, respectively. Conclusion: LH is the most valuable in-dicator for the screening of CPP girls; when two or more indicators were abnormal, especially LH and ultrasound measurement of ovarian diameter, the combination of them can be better screened.