鉴别单纯乳房早发育与中枢性性早熟的临床和实验室评估方法  

Clinical and Laboratorial Assessment for Identifying Isolated Premature Thelarche and Central Precocious Puberty

作　　者：张文[1] 刘丽[1] 李秀珍[1] 周志红[1] 程静[1] 李翠玲[1] 黄洁[1] 赵小媛[2] 

机构地区：[1]广州市儿童医院内分泌代谢科,广州510120 [2]广州市儿童医院内分泌实验室,广州510120

出　　处：《实用儿科临床杂志》2009年第20期1567-1568,1603,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨鉴别单纯乳房早发育(IPT)与中枢性性早熟(CPP)的快速评估方法。方法检测140例乳房早发育女童和80例健康女童[健康对照组:0～3岁30例(C1组),>3～8岁50例(C2组)]血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)基础值。对140例乳房早发育女童进行促性腺激素释放激素类似物(GnRHa)激发试验,比较70例IPT女童[0～3岁20例(IPT1组),>3～8岁50例(IPT2组)]、50例CPP(3～8岁)、20例外周性性早熟(PPP)女童血清FSH、LH激发值。采用SPSS11.0统计学软件,2组间比较采用Mann-Whitney秩和检验,多组间比较采用Kruskal-Wallis秩和检验。结果IPT1组与C1组、IPT2组和CPP组与C2比较,组间LH基础值均有显著性差异(Pa<0.05)。CPP组FSH及E2基础值与C2组比较有显著差异(Pa<0.05)。IPT2组LH/FSH比值与CPP组比较有显著性差异(P<0.05)。GnRHa激发试验后,IPT2组、CPP组与PPP组LH峰值有显著性差异(Pa<0.05)。IPT2组与CPP组FSH峰值无显著性差异(P>0.05)。IPT2组LH峰值/FSH峰值与CPP组比较有显著性差异(P<0.05)。IPT2组和CPP组中,以LH基础值>0.3IU/L作为诊断CPP界限值的灵敏度为82%,特异度为84%,假阴性率为18%,假阳性率为16%;以LH基础值/FSH基础值比值>0.2作为诊断CPP界限值的灵敏度为76%,特异度为80%,假阴性率为24%,假阳性率为20%。结论IPT是源于一种FSH占优势的分泌方式,LH基础值/FSH基础值常<0.2,GnRHa激发试验中LH峰值/FSH峰值常<0.3,而CPP则源于一种LH占优势的分泌方式,LH基础值/FSH基础值常>0.2,GnRHa激发试验中LH峰值/FSH峰值常>0.6。Objective To explore the fast assessment method for identifying isolated premature thelarche（IPT） and central precocious puberty （ CPP ）. Methods The serum basal and stimulated luteinizing hormone （ LH ）, follicle stimulating hormone （ FSH ） and estradiol （ E2 ） in 140 girls with IPT and 80 healthy girls as health control group[0 - 3 years old group（ group CI ） with 30 cases and 〉 3 - 8 years old group （group C2） with 50 cases] were detected. A gonadotropin releasing hormone analogue（GnRHa） stimulation test was performed in 140 girls with IPT. The 140 girls were divided into 3 groups ： IPT group, CPP group, and peripheral precocious puberty group （ PPP group ）. Kruskal - Wallis and Mann - Whimeg tests were performed on the data between every groups, Results For basal LH levels,there were significant differences between IPT1 group and group C1, among IPT2 group, CPP group and group C2 （Pa 〈 0.05 ）. For basal FSH and E2. levels,there were significant differences between CPP group and group C2 （Pa 〈 0.05 ）. For basal LH/FSH ratio, there was significant difference between IPT2 group and CPP group（ P 〈 0.05 ）. After GnRH stimulation test, in peak LH levels, there were significant differences among IPT2 group, CPP group, and PPP group （Pa 〈 0.05 ）. For peak FSH levels, there was no significant difference between IPT2 group and C PP group（ P 〉 0.05 ）. For peak LH/FSH ratios, there was significant difference between IPT2 group and CPP group （ P 〈 0.05 ）. Between ITP2 and CPP group, basal LH level more than 0.3 IU/L could be used to diagnose CPP with 82 percent sensitivity ,84 percent specificity, 18 percent false negative rate and 16 percent false positive rate ;basal LH/FSH ratio more than 0.2 could be used to diagnose CPP with 76 percent sensitivity,80 percent specificity ,24 percent false negative rate and 20 percent false positive rate. Conclusions IPT has an endocrine pattern of dominant FSH,the basal LH/FSH ratio often less than 0.2 and the

关 键 词：乳房早发育 促性腺激素释放激素类似物激发试验 实验室评估 

分 类 号：R725.8[医药卫生—儿科]