昼夜尿促性腺激素与儿童下丘脑-垂体-性腺轴启动的关系  

Correlation between Urinary Gonadotropin and Onset of Hypothalamic-Pituitary-Gonadal Axis during Daytime and Nighttime in Children

作　　者：谢书艳[1] 徐庄剑[1] 马亚萍[1] 张婷婷[1] 王喜平[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》2011年第20期1560-1563,共4页Journal of Applied Clinical Pediatrics

摘　　要：目的评估昼夜自发性尿促性腺激素(Gn)判断儿童下丘脑-垂体-性腺轴(HPGA)启动的价值。方法 40例患儿因生长或发育异常而住院行促性腺激素释放激素类似物激发试验,激发试验前收集昼夜各12 h尿,0000血作为夜间自发性血Gn标本,激发试验0 min血作为日间自发性血Gn标本,并设健康对照(青春期前男、女童各6例)。免疫化学发光法(ICMA)检测其黄体生成素(LH)和卵泡刺激素(FSH)水平。结果 1.患儿:日间尿黄体生成素(DULH)水平、DULH/Cr和日间自发性血LH(SLH)与SLH峰值(PLH)的相关系数(r)为0.648、0.677和0.611,其判断HPGA启动的受试者工作特性曲线下面积(S)分别为0.944、0.926、0.771;夜间上述3项指标分别与PLH的r为0.651、0.638和0.656,其判断HPGA启动的S分别为0.930、0.953和0.819。2.(患儿+健康对照)52例:DULH水平、DULH/Cr、夜间尿LH(NULH)水平和NULH/Cr的判断HPGA启动的S分别为0.961、0.935、0.955和0.959;当截断值分别为DULH水平≥0.036 IU、DULH/Cr≥20.723 0 IU.mol-1、NULH水平≥0.068 IU和NULH/Cr≥34.169 1 IU.mol-1时,其判断HPGA启动的灵敏度分别为100.0%、92.3%、88.5%和88.5%,特异度分别为84.6%、88.5%、96.2%和96.2%;昼夜上述4个指标中,当任一指标判断HPGA启动的特异度达100%时,即截断值分别为DULH水平≥0.220 IU、NULH水平≥0.098IU、DULH/Cr≥163.120 7 IU.mol-1和NULH/Cr≥42.461 0 IU.mol-1时,其对应的灵敏度分别为38.5%、84.6%、11.5%和84.6%;当DULH水平≥0.036 IU且NULH水平≥0.068 IU时,其判断的特异度和灵敏度分别为100.0%和88.5%;当DULH/Cr≥20.723 0IU.mol-1且NULH/Cr≥34.169 1 IU.mol-1时,其特异度和灵敏度分别为96.2%和84.6%。结论 ICMA检测的昼夜尿Gn有助于儿童HPGA启动的判断,其价值不低于自发性血Gn,且昼夜尿Gn的联合检测可能优于其日间或夜间。Objective To evaluate the usefulness of urinary gonadotropin（UGn） for the documentation of hypothalamic-pituitary-gonadal axis（HPGA） status during daytime and nighttime in children. Methods Forty children with disorders during growth or pubertal deve-lopment were hospitalized for gonadotropin-releasing hormone analogue stimulating test.Timed 12-h diurnal and nocturnal urine were collected before the test.The serum samples collected at midnight before the test was for nocturnal serum spontaneous gonadotropin（Gn） detection,and 0 min sample collected during the test was for diurnal serum spontaneous Gn detection.Twelve normal individuals（6 prepubertal boys,6 prepubertal girls） were assigned to the control group.The determinations of luteinizing hormone（LH） and follicle-stimulating hormone were assayed by immunochemiluminometric assay（ICMA）. Results 1.In patients,the correlation coefficient between the serum peak concentrations of stimulated LH（PLH） and the quantities of diurnal urinary LH（DULH） was 0.648,0.677 for DULH concentrations/Cr,and 0.611 for diurnal serum spontaneous LH（SLH）.The areas under the receiver operator characteristic（ROC） curves of the quantities of DULH,DULH concentrations/Cr and diurnal SLH for diagnosing onset of HPGA were 0.944,0.926 and 0.771,respectively.The correlation coefficient between the serum PLH and the quantities of nocturnal urinary LH（NULH） was 0.651,and it was 0.638 and 0.656 for NULH concentrations/Cr,and for nocturnal SLH.The areas under the ROC curves of the quantities of NULH,NULH concentrations/Cr and nocturnal SLH were 0.930,0.953 and 0.819,respectively.2.In 52 individuals（both patients and normal controls）,the areas under the ROC curves of the quantities of DULH,DULH concentrations/Cr,the quantities of NULH and NULH concentrations/Cr were 0.961,0.935,0.955 and 0.959,respectively.When the quantities of DULH,DULH concentrations/Cr,the quantities of NULH,NULH concentrations/Cr were no less than 0.036 IU,20.723 0 IU·mol-1,0.068

关 键 词：促性腺激素 下丘脑-垂体-性腺轴 免疫化学发光法 日间 夜间 儿童 

分 类 号：R725.8[医药卫生—儿科]