Ou-Yang Li-Xue, Yang Fan
Department of Pediatrics, West China Second University Hospital, Chengdu 610041, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2017 Jul;19(7):729-733. doi: 10.7499/j.issn.1008-8830.2017.07.001.
To evaluate the diagnostic value of baseline serum luteinizing hormone (LH) level for central precocious puberty (CPP) in girls.
A total of 279 girls with precocious puberty were subjected to assessment of growth and development, bone age determination, baseline LH test, and follicle-stimulating hormone (FSH) test, gonadotropin-releasing hormone stimulation test, and other related examinations. Of the 279 patients, 175 were diagnosed with CPP and 104 with premature thelarche (PT). The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of baseline LH and FSH levels and their peak levels for CPP, and the correlation between the baseline LH level and the peak LH level was analyzed.
The CPP group had significantly higher bone age, baseline LH and FSH levels, peak LH and FSH levels, and ratio of peak LH level to peak FSH level than the PT group (P<0.01). The ROC curve proved that baseline LH level and peak LH level had good diagnostic values for CPP. Among the three bone age subgroups in the CPP group (7.0-9.0 years, 9.0-11.0 years, and >11.0 years), baseline LH level showed the best diagnostic value in the >11.0 years subgroup, with the largest area under the ROC curve. At a baseline LH level of 0.45 IU/L, the Youden index reached the peak value, and the sensitivity and specificity were 66.7% and 80% respectively, for the diagnosis of CPP. At a peak LH level of 9.935 IU/L, the Youden index reached the peak value, and the sensitivity and specificity were 74.8% and 100% respectively, for the diagnosis of CPP. The baseline LH level was positively correlated with the peak LH level (r=0.440, P<0.01).
Baseline LH level can be used as an primary screening index for the diagnosis of CPP. It has a certain diagnostic value for CPP at different bone ages, and may be used as a monitoring index during the treatment and follow-uP.
评估基础血清促黄体生成素(LH)水平对女童中枢性性早熟(CPP)的诊断价值。
对279例性早熟女童进行生长发育评估、骨龄测定、基础LH检测、促卵泡生成素(FSH)检测、促性腺激素释放激素刺激试验及其他相关检查。279例患者中,175例诊断为CPP,104例诊断为单纯性乳房早发育(PT)。采用受试者工作特征(ROC)曲线评估基础LH和FSH水平及其峰值水平对CPP的诊断价值,并分析基础LH水平与LH峰值水平之间的相关性。
CPP组骨龄、基础LH和FSH水平、LH和FSH峰值水平以及LH峰值水平与FSH峰值水平之比均显著高于PT组(P<0.01)。ROC曲线显示基础LH水平和LH峰值水平对CPP具有良好的诊断价值。在CPP组的三个骨龄亚组(7.0 - 9.0岁、9.0 - 11.0岁和>11.0岁)中,基础LH水平在>11.0岁亚组中诊断价值最佳,ROC曲线下面积最大。基础LH水平为0.45 IU/L时,约登指数达到峰值,诊断CPP的灵敏度和特异度分别为66.7%和80%。LH峰值水平为9.935 IU/L时,约登指数达到峰值,诊断CPP的灵敏度和特异度分别为74.8%和100%。基础LH水平与LH峰值水平呈正相关(r = 0.440,P<0.01)。
基础LH水平可作为诊断CPP的初步筛查指标。其对不同骨龄的CPP均有一定诊断价值,且可作为治疗及随访过程中的监测指标。