Department of Endocrinology and Metabolism, Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China.
Endocrine. 2021 Jun;72(3):633-643. doi: 10.1007/s12020-020-02582-0. Epub 2021 Jan 19.
The distinction between congenital hypogonadotropic hypogonadism (CHH) and constitutional delay of growth and puberty (CDGP) in patients with delayed puberty is difficult to distinguish, but important for timely treatment. The aim of this study is to perform a systematic review and meta-analysis to determine the diagnostic performance of serum inhibin B (INHB) levels for differentiating CHH and CDGP.
PubMed, EMBASE, and Cochrane Library databases were systematically searched from the date of database inception to November 10, 2019 for studies examining the use of serum INHB to discriminate between CHH and CDGP. Pooled odds ratios (OR), sensitivity, specificity, and 95% confidence intervals (CI) were calculated. The Quality Assessment of Diagnostic Studies-2 (QUADAS-2) was used to assess the quality of the included studies. Sub-analyses were performed including that based on testicular volume (TV) and study design.
Seven studies, comprising of 349 patients (96 CHH and 253 CDGP), were included in the meta-analysis. For differentiating between CHH and CDGP, INHB level exhibited good diagnostic accuracy with a pooled sensitivity of 92% (95% confidence interval [CI]: 0.86-0.96, I = 0.4%, p = 0.4343), specificity of 92% (95% CI: 0.88-0.94, I = 68.1%, p = 0.0009), and pooled area under the receiver operating characteristic curve (AUC) of 0.9619. The cut-off values of INHB for boys were 56, 66, 80, 96, 94.7, 111, and 113 pg/ml (assay method standardized to Gen II ELISA). Sub-analyses showed that testicular volume and study design could be a source of statistically significant heterogeneity in specificity. In boys with a testicular volume of ≤3 ml, INHB performed well with a sensitivity of 92%, specificity of 98%, and AUC of 0.9956.
INHB exhibits excellent diagnostic efficiency in distinguishing CHH from CDGP, especially in boys with severe puberty deficiency (TV ≤ 3 ml).
在青春期延迟的患者中，先天性低促性腺激素性性腺功能减退症（CHH）和体质性青春发育延迟（CDGP）之间的区别难以区分，但及时治疗非常重要。本研究旨在进行系统评价和荟萃分析，以确定血清抑制素 B（INHB）水平区分 CHH 和 CDGP 的诊断性能。
从数据库成立日期到 2019 年 11 月 10 日，系统地检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库，以查找使用血清 INHB 来区分 CHH 和 CDGP 的研究。计算合并的优势比（OR）、敏感性、特异性和 95％置信区间（CI）。使用诊断研究质量评估-2（QUADAS-2）评估纳入研究的质量。进行了包括基于睾丸体积（TV）和研究设计的亚分析。
纳入了 7 项研究，共 349 名患者（96 例 CHH 和 253 例 CDGP）进行荟萃分析。对于区分 CHH 和 CDGP，INHB 水平具有良好的诊断准确性，合并敏感性为 92％（95％CI：0.86-0.96，I = 0.4％，p = 0.4343），特异性为 92％（95％CI：0.88-0.94，I = 68.1％，p = 0.0009），汇总受试者工作特征曲线（AUC）下面积为 0.9619。男孩的 INHB 截断值分别为 56、66、80、96、94.7、111 和 113 pg/ml（标准化至 Gen II ELISA 的检测方法）。亚分析表明，睾丸体积和研究设计可能是特异性中存在统计学显著异质性的来源。在睾丸体积≤3ml 的男孩中，INHB 表现良好，其敏感性为 92％，特异性为 98％，AUC 为 0.9956。
INHB 在区分 CHH 和 CDGP 方面具有出色的诊断效率，特别是在睾丸体积严重不足（TV≤3ml）的男孩中。
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