摘要
目的探讨定量测定尿促性腺激素(gonadotropin,Gn),包括尿促黄体生成素(luteinizing hormone,LH)、尿促卵泡刺激素(follicle stimulating hormone,FSH)在判断女童性发育及诊断中枢性性早熟(central precocious puberty,CPP)中的应用价值。方法采用回顾性研究方法,选取2021年12月至2022年10月因乳房发育于安徽省儿童医院儿童内分泌代谢科住院就诊的72例女童作为研究对象。根据促性腺激素释放激素(gonadotropin-releasing hormone,GnRH)激发试验结果将患儿分为CPP组(n=48)和乳房早发育(premature thelarche,PT)组(n=24)。分析晨尿Gn浓度及GnRH激发试验后2 h内的随机尿Gn值,以及GnRH激发试验相关血Gn值。对2组患儿血、尿LH和FSH值及相关参数的差异进行比较分析。统计学方法采用t检验、Mann-whitney U检验、Spearman相关性分析和受试者工作特征(receiver operating characteristic,ROC)曲线分析。结果CPP组与PT组激发后尿FSH值[31.09(24.21,39.18)mIU/ml与45.67(30.78,60.93)mIU/ml,Z=-2.230,P<0.05]比较,CPP组低于PT组;CPP组的晨尿及激发后尿LH值、晨尿和激发后尿LH/FSH值[1.27(0.66,3.57)mIU/ml、9.44(4.58,20.68)mIU/ml和0.07(0.04,0.15)、0.22(0.15,0.50)],与PT组相应指标[0.77(0.60,1.00)mIU/ml、3.71(1.85,6.07)mIU/ml和0.04(0.03,0.06)、0.08(0.06,0.15)]比较,CPP组均高于PT组,差异均有统计学意义(P值均<0.05)。Spearman相关性分析结果显示,晨尿LH值与血LH基值(r=0.645,P<0.05)及激发后尿LH值(r=0.347,P<0.05)呈正相关,激发后尿LH值与血LH峰值呈正相关(r=0.385,P<0.05),激发后尿LH/FSH值与血LH/FSH峰值比呈正相关(r=0.393,P<0.05)。ROC曲线分析结果显示,当晨尿LH值≥1.12 mIU/ml时,其诊断CPP的敏感度为60.0%,特异度为86.4%;激发后尿LH值≥8.23 mIU/ml时,其诊断CPP的敏感度和特异度分别为53.3%和95.7%。结论检测尿Gn可以作为一种非侵入性的、简便的诊断方法,对判断女童的性发育有一定的意义。
Objective To explore the application value of quantitative determination of urinary gonadotropin(Gn),including urinary luteinizing hormone(LH)and urinary follicle stimulating hormone(FSH)in judging the sexual development and the diagnose of central precocious puberty(CPP)in girls.Method From December 2021 to October 2022,72 girls who were hospitalized in the Department of Endocrinology and Metabolism in Children,Anhui Provincial Children's Hospital due to breast development were selected by retrospective study.Based on the results of the gonadotropin-releasing hormone(GnRH)stimulation test,these children were divided into two groups:CPP group(n=48)and premature thelarche(PT)group(n=24).The morning urinary Gn concentration,random urine Gn concentration within 2 hours post-GnRH stimulation test,and blood Gn concentration associated with the GnRH stimulation test were analyzed,and the levels of LH and FSH in blood and urine along with related parameters between two groups were compared and analyzed.Statistical methods performed by t-test,Mann-Whitney U tests,Spearman correlation analysis,and receiver operating characteristic(ROC)curve analysis.Result Urinary FSH concentrations post-stimulation in CPP group were significantly lower than that in PT group[31.09(24.21,39.18)mIU/ml vs 45.67(30.78,60.93)mIU/ml,Z=-2.230,P<0.05].Morning urinary and post-stimulation urinary LH,as well as morning urinary and post-stimulation urinary LH/FSH in CPP group were 1.27(0.66,3.57)mIU/ml,9.44(4.58,20.68)mIU/ml and 0.07(0.04,0.15),0.22(0.15,0.50).Meanwhile,the corresponding indexes in PT group were 0.77(0.60,1.00)mIU/ml,3.71(1.85,6.07)mIU/ml and 0.04(0.03,0.06),0.08(0.06,0.15).The expression levels of the four indicators in CPP group were higher than those in PT group(all P<0.05).Spearman correlation analysis showed that morning urinary LH was positively correlated with the blood LH basal value(r=0.645,P<0.05)and urinary LH after stimulation(r=0.347,P<0.05),urinary LH after stimulation was positively correlated with the blood LH peak value(r=0.385,P<0.05),and urinary LH/FSH after stimulation was positively correlated with blood LH/FSH peak ratio(r=0.393,P<0.05).ROC curve analysis showed that when the morning urinary LH was≥1.12 mIU/ml,the sensitivity and specificity of diagnosis for CPP were 60.0%and 86.4%.When the urinary LH was≥8.23 mIU/ml after stimulation,the sensitivity and specificity of diagnosis for CPP were 53.3%and 95.7%.Conclusion The detection of urinary Gn can be used as a non-invasive and simple diagnostic method,which has certain significance in judging the sexual development of girls.
作者
余丹
邓茜
王娟娟
高健
陈雨青
Yu Dan;Deng Qian;Wang Juanjuan;Gao Jian;Chen Yuqing(Department of Endocrinology and Metabolism in Children,Anhui Provincial Children's Hospital,Anhui,Hefei 230022,China)
出处
《发育医学电子杂志》
2025年第1期56-61,65,共7页
Journal of Developmental Medicine (Electronic Version)
基金
安徽医科大学校科研基金(2019xkj080)。
关键词
尿黄体生成素
女童
尿卵泡刺激素
促性腺激素
性早熟
Urinary luteinizing hormone
Girl
Urinary follicle stimulating hormone
Gonadotropin
Precocious puberty
作者简介
通信作者:陈雨青(Email:894839405@qq.com)。
