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中华诊断学电子杂志 ›› 2023, Vol. 11 ›› Issue (02) : 109 -114. doi: 10.3877/cma.j.issn.2095-655X.2023.02.008

内分泌代谢性疾病诊治

基础黄体生成素水平对女童中枢性性腺启动状态的预测能力分析
侯悦1, 刘福朋2, 张艳红2, 张梅2, 班博2, 赵倩倩2, 张红丽2, 李艳英2,()   
  1. 1. 272013 济宁医学院临床医学院
    2. 272029 济宁医学院附属医院内分泌科
  • 收稿日期:2023-02-27 出版日期:2023-05-04
  • 通信作者: 李艳英
  • 基金资助:
    济宁市重点研发计划项目(2020YXNS001)

The predictive power of basal luteinizing hormone level for central gonadal activation states in girls

Yue Hou1, Fupeng Liu2, Yanhong Zhang2, Mei Zhang2, Bo Ban2, Qianqian Zhao2, Hongli Zhang2, Yanying Li2,()   

  1. 1. Department of Clinical Medicine, Jining Medical University, Jining 272013, China
    2. Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2023-02-27 Published:2023-05-04
  • Corresponding author: Yanying Li
引用本文:

侯悦, 刘福朋, 张艳红, 张梅, 班博, 赵倩倩, 张红丽, 李艳英. 基础黄体生成素水平对女童中枢性性腺启动状态的预测能力分析[J/OL]. 中华诊断学电子杂志, 2023, 11(02): 109-114.

Yue Hou, Fupeng Liu, Yanhong Zhang, Mei Zhang, Bo Ban, Qianqian Zhao, Hongli Zhang, Yanying Li. The predictive power of basal luteinizing hormone level for central gonadal activation states in girls[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2023, 11(02): 109-114.

目的

探讨基础黄体生成素(LH)水平对女童中枢性性腺启动状态的预测能力。

方法

选取2015年2月至2022年8月于济宁医学院附属医院住院检查的8岁前出现第二性征发育,并完成促性腺激素释放激素类似物激发试验的343例女童,收集其一般临床资料、实验室及影像学检查结果,根据激发结果分为单纯性乳房早发育(PT)组(n=114)、部分性中枢性性早熟(CPP)组(n=118)和完全性CPP组(n=111)。Logistic回归分析PT和完全性CPP的独立影响因素,受试者工作特征(ROC)曲线分析独立影响因素对PT和完全性CPP的预测能力。

结果

PT、部分性CPP和完全性CPP组的基础LH水平分别为0.06(0.01,0.16)U/L、0.30(0.12,0.56)U/L、1.50(0.72,2.83)U/L,3组比较差异有统计学意义(H=164.74,P<0.01)。年龄、基础LH、雌二醇水平和子宫体积是PT的独立影响因素;基础LH、雌二醇水平和子宫体积是完全性CPP的独立影响因素。基础LH水平是PT和完全性CPP的最佳预测指标,AUC分别为0.874和0.878。基础LH水平预测PT的最佳切点为0.185 U/L(敏感度83.90%,特异度75.90%),预测完全性CPP的最佳切点为0.435 U/L(敏感度80.50%,特异度84.10%)。

结论

基础LH水平对女童中枢性性腺启动状态具有很好的预测能力,可以作为CPP的早期筛查指标。

Objective

To investigate the predictive power of basal luteinizing hormone (LH) level for central gonadal activation states in girls.

Methods

A total of 343 girls who developed secondary sex characteristics before the age of 8 years old and were hospitalized in the Affiliated Hospital of Jining Medical University from February 2015 to August 2022 were included in this study. The general clinical data were collected and the gonadotropin-releasing hormone analogue (GnRHa) stimulation test was performed. Based on the peak of LH in the GnRHa stimulation test, these girls were categorized into three groups: premature thelarche (PT), partial central precocious puberty (CPP), and complete CPP. The Logistic regression was used to clarify the independent correlation factors of PT and complete CPP. Receiver operating characteristic (ROC) curve was applied to compare the predictive power of the independent factors for PT and complete CPP.

Results

Basal LH level showed significant differences between PT, partial CPP, and complete CPP groups with quartiles of 0.06(0.01, 0.16)U/L, 0.30(0.12, 0.56)U/L, and 1.50(0.72, 2.83)U/L, respectively. The difference between the three groups was meaningful in statistic (H=164.74, P<0.01). Age, basal LH, estradiol level, and uterine volume were independent influential factors of PT. Basal LH, estradiol level, and uterine volume were independent influential factors for complete CPP. Basal LH level was the best predictor for PT and complete CPP with AUCs of 0.874 and 0.878, respectively. The optimal cut-points of basal LH level for predicting PT and complete CPP were 0.185 U/L (sensitivity 83.90%, specificity 75.90%) and 0.435 U/L (sensitivity 80.50%, specificity 84.10%), respectively.

Conclusion

Basal LH level is a valuable predictor of central gonadal activation states in girls, and can be used as an early screening index for CPP.

表1 3组第二性征发育患儿一般资料比较
项目 完全性CPP组(n=111) 部分性CPP组(n=118) PT组(n=114) 统计量 P
年龄(岁,±s) 8.33±0.72ab 8.12±0.74 7.47±1.07c F=8.22 <0.01
身高(cm,±s) 136.26±6.48ab 133.98±6.42 129.65±8.06c F=3.19 <0.05
体重(kg,±s) 33.91±6.34ab 31.54±6.36 29.34±7.05c F=0.57 >0.05
BMI(kg/m2±s) 18.15±2.37ab 17.46±2.59 17.26±2.75 F=0.71 >0.05
BMISDS[M(P25P75)] 1.35(0.77,1.89) 0.99(0.24,1.81) 0.91(0.17,1.76) H=5.44 >0.05
骨龄(岁,±s) 10.40 ±1.14ab 9.79 ±1.38 8.80±1.75 F=9.38 <0.01
骨龄年龄差[岁,M(P25P75)] 2.13(1.44,2.78)ab 1.84(1.13,2.55) 1.32(0.53,2.13)c H=23.91 <0.01
基础LH[U/L,M(P25P75)] 1.50(0.72,2.83)ab 0.30(0.12,0.56) 0.06(0.01,0.16)c H=164.74 <0.01
基础FSH[U/L,M(P25P75)] 4.69(3.16,5.97)ab 3.02(2.08,4.03) 2.04(1.26,3.14)c H=88.04 <0.01
催乳素[nmol/L,M(P25P75)] 0.34(0.25,0.44) 0.31(0.23,0.39) 0.30(0.25,0.40) H=1.53 >0.05
雌二醇[pmol/L,M(P25P75)] 159.14(105.65,210.96)ab 109.07(77.07,158.74) 82.31(58.09,124.60)c H=46.01 <0.01
基础LH/FSH[M(P25P75)] 0.29(0.16,0.53)ab 0.10(0.06,0.15) 0.03(0.01,0.08)c H=130.95 <0.01
峰值LH[U/L,M(P25P75)] 29.68(23.34,44.12)ab 9.07(7.54,12.05) 3.29(2.05,4.38)c H=303.93 <0.01
峰值FSH(U/L,±s) 22.21±8.94ab 13.73 ±5.51 13.39±5.52 F=9.01 <0.01
峰值LH/FSH[M(P25P75)] 1.65(1.33,2.14)ab 0.76(0.54,1.07) 0.22(0.15,0.34)c H=249.31 <0.01
IGF-1(ng/ml,±s) 346.43±110.43ab 295.55±98.26 252.28 ±67.30c F=6.46 <0.01
IGF-1SDS[M(P25P75)] 1.43(0.87,1.99)ab 1.13(0.08,1.79) 1.19(0.10,1.61) H=12.44 <0.01
IGFBP-3(μg/ml,±s) 5.72±1.24b 5.52±0.99 5.23±0.83c F=3.34 <0.05
Hb(g/L,±s) 130.87±8.28 130.84±8.68 130.18±7.81 F=0.56 >0.05
ALT[U/L,M(P25P75)] 11.55(10.00,15.50) 11.85(10.17,15.03) 11.35(9.97,14.30) H=1.07 >0.05
ALB(g/L,±s) 45.47±2.84ab 46.89 ±3.84 46.67±2.64 F=1.48 >0.05
Cr(μmol/L,±s) 36.81±7.31 38.64 ±7.36 38.53±8.35 F=1.25 >0.05
BUN(mmol/L,±s) 3.60±0.83b 3.68±0.74 4.05±0.92c F=2.05 >0.05
TG[mmol/L,M(P25P75)] 0.77(0.58,0.95) 0.73(0.56,0.98) 0.64(0.54,0.90) H=4.38 >0.05
TC(mmol/L,±s) 3.66±0.54 3.74±0.68 3.73±0.67 F=1.02 >0.05
HDL-C(mmol/L,±s) 1.32±0.23ab 1.41±0.28 1.39±0.24 F=0.61 >0.05
LDL-C(mmol/L,±s) 2.03±0.52 2.07±0.52 2.08±0.51 F=0.09 >0.05
FT3(pmol/L,±s) 7.13±0.76 7.01±0.83 7.38±2.97 F=1.82 >0.05
FT4(pmol/L,±s) 16.80±2.27b 17.26±2.09 18.09±3.43c F=1.73 >0.05
TSH(mU/L,±s) 2.73±1.28 2.55±1.17 2.76±1.11 F=0.09 >0.05
乳腺Tanner分期(例,%)       H=0.09 >0.05
31(27.93) 54(45.76) 89(78.07)    
72(64.86) 59(50.00) 25(21.93)    
8(7.21) 5(4.24) 0    
阴毛分期(例,%)       H=1.77 >0.05
23(50.00) 19(63.33) 17(68.00)    
21(45.65) 11(36.67) 8(32.00)    
2(4.35) 0 0    
子宫体积[cm3M(P25P75)] 4.57(3.35,6.32)ab 2.99(1.93,3.86) 1.98(1.35,2.60)c H=81.39 <0.01
表2 PT和完全性CPP独立影响因素分析
图1 PT和完全性CPP的独立影响因素ROC曲线分析注:a图为PT的独立影响因素ROC曲线分析;b图为完全性CPP的独立影响因素ROC曲线分析。LH为黄体生成素;E2为雌二醇
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