尿促性腺激素检查在儿童促性腺激素释放激素类似物激发试验中的价值  

Value of Urinary Gonadotropin Determinations during Gonadotropin-Releasing Hormone Analog Stimulation Testing in Children

作　　者：王喜平[1] 徐庄剑[1] 马亚萍[1] 张文杰[1] 庞兴甫[1] 王勍[1] 

机构地区：[1]苏州大学附属第四医院儿科,江苏无锡214062

出　　处：《实用儿科临床杂志》2010年第20期1550-1552,1567,共4页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨尿促性腺激素(UGn)检查在儿童促性腺激素释放激素类似物(GnRHa)激发试验中的临床价值。方法 50例生长或发育异常患儿住院行GnRHa激发试验,收集注射曲普瑞林后连续5个分段尿(首段1.5 h,其余各段为1.0 h),应用免疫化学发光分析法检测黄体生成素(LH)和卵泡刺激素(FSH)水平。结果 1.分段UGn峰值:3.5 h时限内尿LH(ULH)含量峰值、ULH/肌酐(Cr)的峰值指标分别与血LH峰值(PLH)的相关系数(r)以及ULH含量峰值/UFSHs(与ULH峰值同标本的FSH)指标与血PLH/FSH峰值(PFSH)的r值分别为0.852、0.774和0.899,4.5 h时限内上述相应指标的r值分别为0.836、0.774和0.894;3.5 h时限内此三指标诊断下丘脑-垂体-性腺轴(HPGA)启动的受试者工作特性(ROC)曲线下面积分别为0.960、0.923和0.907,4.5 h时限内的曲线下面积分别为0.952、0.928和0.905。除2.5 h时限内ULH/Cr的峰值与血PLH的r值(0.809)、5.5 h时限内的ULH含量峰值/UFSHs与血PLH/PFSH的r值(0.904)外,2.5 h和5.5 h时限内的所有上述相应指标值均不高于3.5 h和4.5 h2个时限内相应指标的高值。2.各时段(分段的和)UGn:2.5 h、3.5 h、4.5 h和5.5 h时段ULH水平分别与血PLH的r值为0.815、0.842、0.852和0.814,其诊断HPGA启动的ROC曲线下面积分别为0.913、0.944、0.958和0.923;上述相应时段ULH/Cr分别与血PLH的r值为0.802、0.831、0.844和0.814,其诊断HPGA启动的ROC曲线下面积分别为0.911、0.940、0.955和0.919。3.血自发性促性腺激素(Gn):血自发性LH(SLH)与血PLH的r值为0.603,血SLH/自发性FSH(SFSH)与血PLH/PFSH的r值为0.566,SLH和SLH/SFSH诊断HPGA启动的ROC曲线下面积分别为0.792和0.675。4.诊断HPGA启动的灵敏度和特异度:当4.5 h时限内ULH/Cr峰值和4.5 h时段ULH含量的截断值(Youden指数最高时)分别≥492.581 8 IU.mol-1和≥0.289 3 IU.L-1时,其灵敏度分别为96.3%和92.6%,特异度均为91.3%。结论在GnRHa激发试验中ICMA检测的UGn价值优于血自发性Gn。Objective To assess the utility of timed urinary gonadotropin（UGn） detection as a substitute for serum gonadotropin determinations during gonadotropin-releasing hormone analog（GnRHa） stimulation testing in children.Methods Studies were performed during 50 GnRHa stimulation tests in children with a variety of growth or pubertal development disorders.Five consecutive timed urine samples were collected after triptorelin injection in all cases（the first was timed as 1.5-hour urine,and the others were timed as 1.0-hour urine respectively）.The luteinizing hormone（LH） and follicle-stimulating hormone（FSH） were measured by immunochemiluminescent assays.Results 1.The peak UGn of the consecutive timed urine samples：the correlation coefficient between the quantities of peak urinary LH（ULH） and serum concentrations of peak stimulated LH（PLH） was 0.852 in first 3.5 h after triptorelin injection,for the peak ratio of ULH concentrations/creatinine（Cr） and serum PLH 0.774,and for quantities of peak ULH/quantities of UFSHs,UFSHs was the quantities of urinary FSH in the same sample,and serum PLH/peak stimulated FSH（PFSH） 0.899.In the first 4.5 h,the correlation coefficient between the quantities of peak ULH and serum PLH was 0.836,for the peak ratio of ULH concentrations/Cr and serum PLH 0.774,for quantities of peak ULH/quantities of UFSHs and serum PLH/PFSH 0.894.The areas under the receiver operating characteristic（ROC）curves of quantities of peak ULH,peak ULH concentrations/Cr,quantities of peak ULH/quantities of UFSHs for the diagnosis of onset of hypothalamic-pituitary-gonadal axis（HPGA） were 0.960,0.923 and 0.907,respectively in the first 3.5 h after triptorelin injection,while in the first 4.5 h,were 0.952,0.928 and 0.905,respectively.Excluding the correlation coefficient between serum PLH and peak ULH concentrations/Cr（0.809） in the first 2.5 h,and between serum PLH/PFSH and quantities of peak ULH/quantities of UFSHs（0.904） in the first 5.5 h,the above other correlation

关 键 词：促性腺激素释放激素类似物激发试验 尿 下丘脑-垂体-性腺轴 免疫化学发光法 儿童 

分 类 号：R725.8[医药卫生—儿科]