促黄体生成素基础值<0.1 IU/L的外周性与中枢性性早熟女童的临床特点比较

目的分析促黄体生成素（LH）基础值<0.1 IU/L的外周性性早熟（PPP）及中枢性性早熟（CPP）女童的临床特点，以指导临床合理采用促性腺激素释放激素（GnRH）激发试验诊断性早熟。 方法收集2016年2月至2018年8月在扬州大学临床医学院苏北人民医院儿童性早熟门诊就诊的LH基础值<0.1 IU/L的PPP女童（263例）及CPP女童（20例）为研究对象，比较2组间的临床特点的差异，采用Logistic回归分析进行CPP危险因素的分析，采用受试者工作特征曲线（ROC）评价相关指标对CPP的诊断价值。 结果PPP组患儿与CPP组患儿在乳房开始发育年龄、就诊年龄、就诊身高、体质量指数、遗传靶身高、生长速率、子宫内膜出现情况、直径>4 mm卵泡所占比例及FSH基础值方面比较的差异均无统计学意义（P>0.05）；在骨龄超前［（3.7±9.8）个月 vs （15.3±9.6）个月］、卵巢体积［1.1（0.7，1.7）ml vs 1.8（1.3，2.4）ml］、子宫长度［18（16，20）cm vs 21（16，24）cm］、子宫容积［0.9（0.6，1.4）ml vs 1.3（0.8，2.4）ml］、雌二醇水平［18.4（18.3，25.3）pmol/L vs 33.3（18.4，43.0）pmol/L］、预测身高受损值［（-0.4±7.4）cm vs （5.5±5.7）cm］方面，2组间比较，差异均具有统计学意义（t=-4.908，P<0.001；Z=-3.916，P<0.001；Z=-2.309，P=0.021；Z=-3.227，P=0.001；Z=-3.182，P=0.001；t=1.223，P=0.001）。Logistic回归分析发现骨龄超前（OR=0.844）及子宫容积（OR=0.330）是诊断CPP的2个独立危险因素。骨龄超前及子宫容积对LH基础值<0.1 IU/L时CPP的诊断预测价值的AUC分别为0.830、0.716（P<0.001）。骨龄超前的切割值为11.5个月时对应的约登指数最大（0.629），敏感度为80.0%、特异度为82.9%；子宫容积的切割值为2.085 ml时对应的约登指数最大（0.401），敏感度为45.0%、特异度为95.1%。 结论LH基础值小于0.1 IU/L的性早熟女童不能完全排除下丘脑-垂体-性腺轴启动，如骨龄超前11.5个月以上或子宫容积大于2.085 ml应做GnRH激发试验以排除CPP可能。

Comparison of clinical characteristics between peripheral and central precocious puberty girls with basal luteinizing hormone less than 0.1 IU/L

ObjectiveTo compare the clinical characteristics of peripheral precocious puberty (PPP) and central precocious puberty (CPP) girls with a basal luteinizing hormone (LH) level less than 0.1 IU/L to guide the reasonable clinical diagnosis of precocious puberty by the gonadotropin-releasing hormone (GnRH) stimulating test. MethodsFrom February 2016 to August 2018, PPP girls (263 cases) and CPP girls (20 cases) with a basal LH value<0.1 IU/L who visited the Subei Hospital of Clinical Medical College of Yangzhou University were studied. Data were compared between groups, and logistic regression analysis was perform to identify the relevant risk factors and ROC curve was used to evaluate the diagnostic value of related indicators. ResultsThere were no significant differences between the PPP group and the CPP group in breast development age, age at visit, height at visit, body mass index, genetic target height, growth rate, endometrium appearance, proportion of>4 mm follicles, or basal FSH value. There were significant differences between the two groups in advanced bone age [(3.7±9.8) months vs (15.3±9.6) months, t=-4.908, P<0.001], ovary volume [1.1 (0.7, 1.7) ml vs 1.8 (1.3, 2.4) ml, Z=-3.916, P<0.001], uterine length [18 (16, 20) cm vs 21 (16, 24) cm, Z=-2.309, P=0.021], uterine volume [0.9 (0.6, 1.4) ml vs 1.3 (0.8, 2.4) ml, Z=-3.227, P=0.001], estradiol [18.4 (18.3, 25.3) pmol/L vs 33.3 (18.4, 43.0) pmol/L, Z=-3.182, P=0.001], and predicted compromised adult height (PAH-TH) [(-0.4±7.4) cm vs (5.5±5.7) cm, t=1.223, P=0.001]. Logistic regression analysis demonstrated that the months of advanced bone age (OR=0.844) and uterine volume (OR=0.330) were two independent risk factors for the diagnosis of CPP. ROC curve analysis showed that the area under the curve (AUC) of advanced bone age and uterine volume was 0.830 and 0.716, respectively. When the cutoff value for advanced bone age was 11.5 months, the sensitivity and specificity for diagnosis of CPP were 80.0% and 82.9%, respectively. When the cutoff value for uterine volume was 2.085 mL, the sensitivity and specificity for diagnosis of CPP were 45.0% and 95.1%, respectively. ConclusionThe hypothalamic-pituitary-gonadal axis (HPGA) activation cannot be completely ruled out if basal LH is less than 0.1 IU/L. In these girls, GnRH stimulation test should be conducted to exclude CPP if the bone age is more than 11.5 months ahead or the uterine volume is greater than 2.085 ml.