促性腺激素释放激素类似物激发试验尿检法对儿童促性腺激素释放激素类似物疗效的判断价值

目的 探讨促性腺激素释放激素类似物(GnRHa)激发试验时免疫化学发光分析法(ICMA)检测的无创性尿促性腺激素(UGn)可否用于儿童GnRHa的疗效判断.方法 患儿23例(男4例,女19例).中枢性性早熟17例(均为女童),予GnRHa治疗.青春期预测终身高矮小6例(男4例,女2例),予GnRHa联合生长激素治疗.在治疗前和治疗3个月均行GnRHa激发试验,留激发试验0～3.5 h尿,其中18例留取了激发试验前1d同一时段的日间自发性尿,应用ICMA检测促黄体生成素(LH)和卵泡刺激素(FSH).结果 1.治疗前后GnRHa激发试验时UGn显著性检验:治疗前后的尿促黄体生成素(ULH)水平分别为(1.27±1.63) IU和(0.07±0.06) IU,尿卵泡刺激素(UFSH)水平分别为(6.38±3.85)IU和(0.54±0.30) IU.2.GnRHa激发试验时血清Gn峰值和UGn对GnRHa疗效评估:当血清LH峰值(PLH)和FSH峰值(PFSH)分别≤2.30IU·L-1和2.39 IU·L-时,其判断疗效的灵敏度分别为95.45％和100％,特异度均为100％；当ULH水平和UFSH水平分别≤0.083 IU和1.089 IU时,其灵敏度分别为90.91％和100％,特异度均为100％.3.GnRHa激发试验时血清Gn和UGn分别与其激发试验前的比值对GnRHa疗效评估:当血清PLH/日间自发性血清LH、血清PFSH/日间自发性血清FSH分别≤5.40和2.16时,其灵敏度和特异度均为100％；当其激发试验时ULH水平/日间自发性ULH水平、激发试验时UFSH水平/日间自发性UFSH水平分别≤6.076和2.480时,其灵敏度和特异度也均达100％.结论 GnRHa激发试验时ICMA检测的无创性3.5 h UGn水平、激发试验时3.5 h UGn水平/日间自发性UGn水平指标可能对儿童GnRHa疗效具有判断价值,其中UFSH水平及其与日间自发性UFSH水平比值指标价值可能更大.

Value of Urinary Gonadotropin during Gonadotropin - Releasing Hormone Analog Stimulation Testing in Monitoring Gonadotropin- Releasing Hormone Analog Therapy for Children

Objective To determine whether noninvasive urinary gonadotropin(UGn) following gonadotropin releasing hormone analog(GnRHa) stimulation testing can be used for monitoring GnRHa therapy for children. Methods Seventeen female cases who suffered with central precocious puberty were treated with Diphereline.Other 6 cases(4 males,2 females) with short stature of predicted adult height were treated with growth hormone co-treatment within Diphereline.GnRHa stimulation testing was performed a week before the therapy,and repeated 3 months after the therapy.The 3.5 h timed urine collections were obtained during the testing,as well as urine in 18 cases were collec-ted the day before the testing.Luteinizing hormone(LH) and follicle stimulating hormone(FSH) were assayed by immunochemiluminometric assay(ICMA). Results 1.The comparison for UGn content during GnRHa stimulation testing between before and after therapy:Urinary sti-mulated LH content(ULH) before and after therapy were respectively(1.27±1.63) IU and(0.07±0.06) IU;for urinary stimulated FSH content(UFSH) were(6.38±3.85) IU and(0.54±0.30) IU.2.Serum peak Gn and UGn during GnRHa stimulation testing for monitoring therapy:When serum peak LH(PLH) and peak FSH(PFSH) were respectively no more than 2.30 IU·L-1 and 2.39 IU·L-1,the sensiti-vities to assess hypothalamic-pituitary-gonadal axis suppression were 95.45% and 100%,respectively,and both specificities were 100%.For the ULH and UFSH were respectively no more than 0.083 IU and 1.089 IU,the sensitivities were respectively 90.91% and 100%,and both specificities were 100%.3.The ratio of serum peak Gn to serum spontaneous Gn and the ratio of urinary stimulated Gn content to urinary spontaneous Gn content:When the ratio of PLH to serum spontaneous LH,the ratio of PFSH to serum spontaneous FSH,the ratio of ULH to urinary spontaneous LH content and the ratio of UFSH to urinary spontaneous FSH content were respectively no more than 5.40,2.16,6.076 and 2.480,the sensitivities and specificities were all 100%. Conclusions Noninvasive 3.5 h timed UGn content and the ratio of 3.5 h UGn content to urinary spontaneous Gn content by ICMA during GnRHa stimulation testing may be of usefulness in monitoring GnRHa therapy for children,especially the UFSH content and the ratio of UFSH to urinary spontaneous FSH content.