基础性激素水平和盆腔B超检测对快进展型中枢性性早熟诊断的预测价值  

Value of basal sex hormone levels and pelvic ultrasonography in diagnosis of rapid-progressive central precocious puberty

作　　者：陈瑾[1] 林蕴[1] 王英姿[1] 林爱琳[1] 尹敏康 CHEN Jin;LIN Yun;WANG Yingzi;LIN Ailin;YIN Minkang(Department of Pediatrics,Taizhou Municipal Hospital,Taizhou 318000,China)

机构地区：[1]台州市立医院儿科,318000

出　　处：《浙江医学》2022年第21期2269-2273,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020KY369)。

摘　　要：目的探讨基础性激素水平和盆腔B超检测对快进展型中枢性性早熟(RP-CPP)的诊断价值。方法选取2019年6月至2021年6月在台州市立医院儿科就诊的性早熟女童110例,根据青春期演变,分为RP-CPP组(40例)和慢进展型性早熟(SP-PP)组(70例),测量所有患儿身高、体重;行性激素水平测定,包括促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)、血清胰岛素样生长因子-1(IGF-1)和胰岛素样生长因子结合蛋白3(IGF-BP3);拍摄左手腕骨龄X线片,评估骨龄与实际年龄(BA/CA)比值;对患儿子宫及附件行B超检测。结果RP-CPP组和SP-PP组患儿初诊时身高标准差评分(H-SDS)、BA/CA比值、IGF-1标准差评分(IGF-1-SDS)、黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E2)、子宫长径、卵巢容积比较差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示子宫长径、卵巢容积、LH基础值均是RP-CPP的主要危险因素(均P<0.05)。子宫长径20.5 mm、卵巢容积1.78 ml、LH基础值0.19 U/L是预测RP-CPP的最佳截断值,AUC分别为0.87、0.81、0.72,灵敏度分别为0.850、0.850、0.725,特异度分别为0.743、0.671、0.657。结论子宫长径、卵巢容积、LH基础值可能是早期识别女童RP-CPP的指标,可帮助决定及早行促性腺激素释放激素激发试验以明确诊断。Objective To explore the value of basal sex hormone levels and pelvic ultrasonography in diagnosis of rapid-progressive central precocious puberty(RP-CPP).Methods One hundred and ten girls with precocious puberty who were treated in the Department of Pediatrics of Taizhou Municipal Hospital from June 2019 to June 2021 were enrolled.According to puberty evolution,they were divided into RP-CPP group(n=40)and slowly progressive/transient precocious puberty(SP-PP)group(n=70).The height and weight of all children were measured.Sex hormone levels were measured,including follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),serum insulin like growth factor-1(IGF-I)and insulin-like growth factor binding protein 3(IGF-BP3).The bone age film of left wrist was taken to assess bone age to chronological age(BA/CA)ratio and ultrasonographic examination of uterus and its accessories was performed.Results There were significant differences in the height standard deviation score(H-SDS),BA/CA,IGF-1 score,LH,FSH and E2 levels,uterine long diameter and ovarian volume between RP-CPP group and SP-PP group(all P<0.05).Multivariate logistic regression analysis showed that uterine long diameter,ovarian volume and basal LH were the risk factors for RP-CPP.Uterine long diameter 20.5 mm,ovarian volume 1.78 ml,and basel LH 0.19 U/L were the best cut-off values for predicting RP-CPP,and the areas under the receiver operating characteristics(ROC)curve were 0.87,0.81,and 0.72.The sensitivity were 0850,0.850,0.725,the specificity were 0.743,0.671,0.657.Conclusion Uterine long diameter,ovarian volume and basal LH may be indicators for early identification of girls with RP-CPP,and help to select patients who require GnRH stimulation tests for early detection.

关 键 词：中枢性性早熟 性激素 B超 

分 类 号：R725.8[医药卫生—儿科]