[单次或重复曲普瑞林刺激试验在特发性低促性腺激素性性腺功能减退症与体质性青春期延迟鉴别诊断中的临床价值]

[Clinical values of single or repeated triptorelin stimulating test in the differential diagnosis between idiopathic hypogonadotropic hypogonadism and constitutional delayed puberty].

作者信息

Mao Jiang-Feng, Wu Xue-Yan, Lu Shuang-Yu, Nie Min

机构信息

Department of Endocrinology, Key Laboratory of Ministry of Health, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.

出版信息

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2011 Oct;33(5):566-70.

PMID:22338144

Abstract

OBJECTIVE

To investigate the values of single or repeated luteinizing hormone (LH) releasing hormone analogue (triptorelin) stimulating test in the differential diagnosis between idiopathic hypogonadotropic hypogonadism (IHH) and constitutional delayed puberty (CDP).

METHODS

Male patients (n = 133) without puberty onset after the age of 14 were recruited for triptorelin stimulating test and were followed up for 24 - 48 months until the diagnosis were confirmed: 86 were IHH and the other 47 were CDP. Repeated triptorelin stimulating tests were conducted in 9 IHH patients and 13 CDP patients one year after the first stimulating tests with an attempt to evaluate the dynamic change of hypothalamus-pituitary-testis axis function. The relationship between the final diagnosis and the peak LH value (LH(max)), and the changes of repeated LH(max) were investigated.

RESULTS

In the single triptorelin stimulating test, LH(max) was (1.9 +/- 1.2) U/L in IHH group, which was significantly lower than that in CDP group [(13.7 +/- 8.3) U/L] (P < 0.01); 75 IHH patients (87.2%) had a LH(max) lower than 4 U/L, while only 2 CDP patients (4.3%) had a LH(max) lower than 4 U/L. When LH(max) < 4U/L was used as a criteria for the diagnosis of IHH, the single triptorelin stimulating test had a sensitivity of 87.2%, a specificity of 95.7%, and a positive predictive value of 97.4%. The repeated triptorelin stimulating tests performed one year later showed that the LH(max) in the 9 IHH patients increased from (4.7 +/- 2.5) U/L to (5.1 +/- 3.3) U/L (P = 0.78), while that in the 13 CDP patients increased from (10.7 +/- 3.3) U/L to (24.5 +/- 5.7) U/L (P < 0.05).

CONCLUSIONS

A single triptorelin stimulating test is highly effective in differentiating IHH from CDP. For some patients without definitive diagnosis, a repeated triptorelin stimulating test performed one year later may provide more valuable information on the dynamic change of the hypothalamus-pituitary-testis axis function.

摘要

目的

探讨单次或重复促黄体生成素（LH）释放激素类似物（曲普瑞林）刺激试验在特发性低促性腺激素性性腺功能减退症（IHH）与体质性青春期延迟（CDP）鉴别诊断中的价值。

方法

招募14岁后仍未开始青春期发育的男性患者（n = 133）进行曲普瑞林刺激试验，并随访24 - 48个月直至确诊：其中86例为IHH，47例为CDP。9例IHH患者和13例CDP患者在首次刺激试验1年后进行重复曲普瑞林刺激试验，以评估下丘脑 - 垂体 - 睾丸轴功能的动态变化。研究最终诊断与LH峰值（LH(max)）以及重复LH(max)变化之间的关系。

结果

在单次曲普瑞林刺激试验中，IHH组的LH(max)为（1.9±1.2）U/L，显著低于CDP组[（13.7±8.3）U/L]（P < 0.01）；75例IHH患者（87.2%）的LH(max)低于4 U/L，而CDP组仅2例患者（4.3%）的LH(max)低于4 U/L。以LH(max) < 4U/L作为IHH诊断标准时，单次曲普瑞林刺激试验的敏感性为87.2%，特异性为95.7%，阳性预测值为97.4%。1年后进行的重复曲普瑞林刺激试验显示，9例IHH患者的LH(max)从（4.7±2.5）U/L升至（5.1±3.3）U/L（P = 0.78），而13例CDP患者的LH(max)从（10.7±3.3）U/L升至（24.5±5.7）U/L（P < 0.05）。