【作者】 张静；

【导师】 陈瑞敏；

【作者基本信息】 福建医科大学 ， 儿科学， 2019， 硕士

【摘要】 目的探讨促性腺激素基础值及盆腔B超对不同体块指数（BMI）女孩中枢性性早熟（CPP）的诊断价值。方法选取2014年至2018年在福建省福州儿童医院内分泌科就诊的6⁸岁出现乳房发育、诊断为CPP及单纯性乳房早发育（PT）的女孩611例,就诊时乳房发育Tanner分期为B₂或B₃期且未出现月经初潮。根据年龄-性别对应的BMI百分位数分为正常体重（444例）、超重（90例）及肥胖组（77例）。检查项目包括体格检查、骨龄评估、促性腺激素释放激素（GnRH）激发试验、盆腔B超等。应用SPSS18.0进行统计分析,两样本比较采用两样本t检验或Mann-Whitney U检验;数据间的相关分析采用spearman相关分析;绘制受试者工作特征（ROC）曲线探讨促黄体生成素（LH）基础值、促卵泡刺激素（FSH）基础值、LH/FSH基础值、雌二醇（E₂）、子宫长径、子宫体积、卵巢体积对不同体重状态CPP女孩的诊断价值以及区分CPP和PT的最佳界值点。结果1正常体重女孩CPP组243例,PT组201例;超重女孩CPP组57例,PT组33例;肥胖女孩CPP组37例,PT组40例。正常体重、超重、肥胖女孩CPP组及PT组间就诊年龄差异无统计学意义（P>0.05）。2正常体重、超重、肥胖女孩CPP组与PT组比较,基础LH、基础FSH、基础LH/FSH、子宫体积、卵巢体积差异均具有统计学意义（P<0.01）。3正常体重、超重女孩CPP组基础LH与峰LH、基础LH/FSH与峰LH/FSH正相关（P<0.01）;肥胖CPP组LH基础值与LH峰值、基础LH/FSH与峰LH/FSH无相关关系（P>0.05）。4 LH基础值用于正常体重、超重、肥胖女孩CPP诊断的ROC曲线下面积（AUC）分别为0.842、0.843、0.794,约登指数最大时（0.54、0.61、0.48）,基础LH水平的界值分别为0.165IU/L、0.225 IU/L、0.145 IU/L,灵敏度分别为73.3%、66.7%、77.8%,特异度分别为80.4%、93.9%、70.0%。基础FSH、基础LH/FSH、子宫长径、子宫体积、卵巢体积在不同BMI女孩的诊断价值存在差异。5正常体重女孩若采用基础LH>0.165IU/L且基础LH/FSH>0.075,同时子宫体积>1.345ml标准,敏感度42.0%,特异度98.0%。超重女孩若采用基础LH>0.225IU/L且卵巢体积>1.335ml标准,敏感度61.4%,特异度97.0%。肥胖女孩若采用LH>0.145IU/L且子宫体积>2.05ml标准,敏感度21.6%,特异度100%。结论1、正常体重、超重、肥胖女孩的LH基础值最佳诊断界值点存在差异,但均具有较好的诊断价值。2、LH基础值与子宫体积或卵巢体积联合应用可以提高女孩CPP诊断的特异度,可作为不同BMI女孩CPP与PT的鉴别诊断指标。更多还原

【Abstract】 Objective To explore the diagnostic value of basal gonadotropin and pelvic ultrasound in the diagnosis of central precocious puberty(CPP)in girls according to their body mass index(BMI).Method 611 girls presented with breast development at 6~8 years of age,who were diagnosed with CPP or premature thelarche(PT),and visited the Pediatric Endocrinology Clinic at Fuzhou Children’s Hospital of Fujian Province from 2014 to 2018 were enrolled in this study.Breast development in these girls were in Tanner stage 2 or Tanner stage 3 without menarche.The girls were grouped according to their BMI: normal weight(n=444),overweight(n=90)and obesity(n=77).Physical measurements,bone age assessment,gonadotropin-releasing hormone(Gn RH)stimulation test,pelvic ultrasound and other examinations were taken for all girls.SPSS18.0 was used for statistical analysis,Student t-test or Mann-Whitney U was used to analyze the differences between CPP and PT groups.Spearman’s correlation was used to analyze the correlation between peak gonadotropin and basal gonadotropin levels.Receiver operating characteristic curves(ROCs)were constructed to explore the cut-off and diagnostic values to differentiate girls with CPP from PT.Results 1 In the group of normal weight,there were 243 CPP girls and 201 PT girls.In the overweight group,there were 57 CPP girls and 33 PT girls.In the obesity group,there were 37 CPP girls and 40 PT girls.No statistical difference was observed in diagnostic age between CPP and PT girls(all P>0.05).2 Basal LH,FSH and LH/FSH levels and the uterine and ovary volumes were higher in girls with CPP vs.PT in each weight group(P<0.01).3 There was a positive correlation between basal LH value and peak LH,basal LH/FSH value and peak LH /FSH in CPP girls with normal weight,overweight(P<0.01).There were no statistically correlation between basal LH value and peak LH,basal LH/FSH value and peak LH /FSH in CPP girls with obesity(P>0.05).4 The area under the ROC curve(AUC)of LH basal value for CPP diagnosis of normal weight,overweight and obese girls were 0.842,0.843 and 0.794.When the youden index were at the maximum(0.54,0.61,0.48),the cut off values of the basic LH value were 0.165IU/L,0.225IU/L,and 0.145IU/L.The sensitivity were 73.3%,66.7% and 77.8%,and the specificity were 80.4%,93.9%,and 70.0%,respectively.The diagnostic value of basal FSH,basal LH/FSH,uterine length,uterine volume and ovarian volume were different in normal weight,overweight and obese girls.5 For normal-weight girls,if basal LH value >0.165IU/L,basal LH /FSH >0.075 and uterine volume >1.345 ml were used as the cut-offs,the sensitivity was 42.0% and specificity was 98.0%.For overweight CPP girls,if LH basic value >0.225IU/L and ovarian volume >1.335 ml were used as cut-offs,the sensitivity was 61.4% and specificity was 97.0%.For obese girls,if LH>0.145IU/L and uterine volume>2.05 ml were used as cut-offs,the sensitivity was 21.6% and specificity was 100%.Conclusion 1.The best diagnostic value of basal LH for CPP are different in normal weight,overweight and obese girls,but it is reliable to differentiate CPP and PT for all girls.2.The combined application of basal LH and uterine volume or ovarian volume may improve the diagnostic accuracy of CPP girls,CPP and PT could also be distinguished.更多还原