黄体生成素/促卵泡生成素比值对快进展型中枢性性早熟的预测价值研究  

Diagnostic Value of LH/FSH Ratio in Rapidly Progressing Central Precocious Puberty Girls

作　　者：袁淑娴 林一凡 赵艺璇 魏怡 鲁帅[1] 卫海燕[1] YUAN Shuxian;LIN Yifan;ZHAO Yixuan;WEI Yi;LU Shuai;WEI Haiyan(Department of Endocrinology and Metabolism,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院内分泌遗传代谢科,河南省郑州市450018

出　　处：《中国全科医学》2025年第3期352-357,共6页Chinese General Practice

基　　金：河南省科技局项目(212102310438,232102310088);国家重点研发计划(2021YFC2701900)。

摘　　要：背景 中枢性性早熟(CPP)是儿童内分泌常见疾病,近年来呈逐年增加趋势,依据青春期发育进程可分为快进展型中枢性性早熟(RP-CPP)和缓慢进展型中枢性性早熟(SP-CPP)。RP-CPP具有极大危害,其与SPCPP在早期临床鉴别中存在困难,主要依靠随访中青春期发育进程及骨龄进展情况进行判断,目前缺乏有效的实验室检查指标来预测RP-CPP。目的 探讨促黄体生成素(LH)/促卵泡生成素(FSH)比值对RP-CPP的预测价值。方法回顾性选取2020年1月—2022年5月郑州大学附属儿童医院收治的4~10岁CPP女童(n=380),依据青春期发育进程等指标分为RP-CPP组(n=130)及SP-CPP组(n=250),对两组间的临床特征进行对比分析,进行RP-CPP影响因素的单因素和多因素Logistic回归分析,并绘制LH/FSH比值对RP-CPP预测价值的受试者工作特征(ROC)曲线。结果 RP-CPP组女童的身高、体质量、BMI、胰岛素样生长因子1(IGF-1)、骨龄与实际年龄差值、双侧卵巢体积、LH基础值、雌二醇水平、LH基础值/FSH基础值、LH峰值/FSH峰值均高于SP-CPP组(P<0.05)。多因素Logistic回归分析,结果显示,LH基础值(OR=0.882,95%CI=0.686~0.986,P=0.035)及LH峰值/FSH峰值(OR=0.492,95%CI=0.336~0.723,P<0.001)是CPP患者进展为RP-CPP的影响因素。LH基础值/FSH基础值、LH峰值/FSH峰值均与身高、IGF-1、LH基础值、雌二醇水平、LH峰值、卵巢容积及骨龄呈正相关(P<0.05)。ROC曲线显示LH基础值/FSH基础值、LH峰值/FSH峰值较其他指标对RP-CPP的预测价值更高,LH基础值/FSH基础值为0.63时,约登指数最大为0.258[灵敏度为43.1%,特异度为82.7%,ROC曲线下面积(AUC)=0.644],LH峰值/FSH峰值为1.39时,约登指数最大为0.276(灵敏度为74.6%,特异度53.0%,AUC=0.655),二者联合的预测模型优于单一指标预测模型(AUC=0.668)。对未进行临床干预患儿随访6个月后的基础促性腺激素水平进行分析,随访6个月后RP-CPP组的身高增长、ΔLH、ΔFSH、骨龄�Background Central precocious puberty(CPP)is a common endocrine disease in children,which shows an increasing trend year by year in recent years.It can be divided into fast-progressing central precocious puberty(RP-CPP)and slow-progressing central precocious puberty(SP-CPP)through pubertal development.RP-CPP has great harm,but it is difficult to distinguish it from SP-CPP in early clinical stage,mainly relying on the progress of adolescent development and bone age during follow-up.At present,there is a lack of effective laboratory indicators to predict RP-CPP.Objective To investigate the relationship between luteinizing hormone(LH)/follicle-stimulating hormone(FSH)ratio and pubertal development.Methods CPP girls aged 4-10 years old(n=380)admitted to the Children's Hospital Affiliated to Zhengzhou University from January 2020 to May 2022 were regression selected and divided into RP-CPP group(n=130)and SP-CPP group(n=250 cases)according to indicators such as puberal development process.Clinical characteristics of the two groups were compared and analyzed.Univariate and multivariate Logistic regression analysis of the influencing factors of RP-CPP was performed,and ROC curve of LH/FSH ratio on the predictive value of RP-CPP was drawn.Results The height,weight,BMI,IGF-1,difference between bone age and actual age,bilateral ovarian volume,LH base value,estradiol level,LH base value/FSH base value,and LH peak/FSH peak value of girls in RP-CPP group were all higher than those in SP-CPP group,with statistical significance(P<0.05).Regression analysis showed that CPP patients progressed to RP-CPP related serological indexes when LH base value and LH peak/FSH peak were detected.LH base/FSH base value and LH peak/FSH peak were positively correlated with height,IGF-1,LH base value,estradiol level,LH peak,ovarian volume and bone age(P<0.05).ROC curve showed that the LH base/FSH base value and LH peak/FSH peak value were more sensitive and specific than other indexes to the predictive value of RP-CPP.When the LH base/FSH base va

关 键 词：中枢性性早熟 促卵泡激素 黄体生成素 青春期发育 女童 病例对照研究 

分 类 号：R742.89[医药卫生—神经病学与精神病学]