Department of Pediatric Endocrinology and Inborn Metabolic Diseases, Children's Hospital, Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
Department of Ultrasonography, Children's Hospital, Fudan University, Shanghai, 201102, China.
BMC Endocr Disord. 2021 Apr 20;21(1):75. doi: 10.1186/s12902-021-00740-7.
The gold standard for the diagnosis of central precocious puberty (CPP) is gonadotropin-releasing hormone (GnRH) or GnRH analogs (GnRHa) stimulation test. But the stimulation test is time-consuming and costly. Our objective was to develop a risk score model readily adoptable by clinicians and patients.
A cross-sectional study based on the electronic medical record system was conducted in the Children's Hospital, Fudan University, Shanghai, China from January 2010 to August 2016. Patients with precocious puberty were randomly split into the training (n = 314) and validation (n = 313) sample. In the training sample, variables associated with CPP (P < 0.2) in univariate analyses were introduced in a multivariable logistic regression model. Prediction model was selected using a forward stepwise analysis. A risk score model was built with the scaled coefficients of the model and tested in the validation sample.
CPP was diagnosed in 54.8% (172/314) and 55.0% (172/313) of patients in the training and validation sample, respectively. The CPP risk score model included age at the onset of puberty, basal luteinizing hormone (LH) concentration, largest ovarian volume, and uterine volume. The C-index was 0.85 (95% CI: 0.81-0.89) and 0.86 (95% CI: 0.82-0.90) in the training and the validation sample, respectively. Two cut-off points were selected to delimitate a low- (< 10 points), median- (10-19 points), and high-risk (≥ 20 points) group.
A risk score model for the risk of CPP had a moderate predictive performance, which offers the advantage of helping evaluate the requirement for further diagnostic tests (GnRH or GnRHa stimulation test).
中枢性性早熟（CPP）的金标准诊断方法是促性腺激素释放激素（GnRH）或 GnRH 类似物（GnRHa）刺激试验。但该刺激试验耗时且昂贵。我们的目标是开发一种易于临床医生和患者采用的风险评分模型。
本研究为基于电子病历系统的横断面研究，于 2010 年 1 月至 2016 年 8 月在复旦大学附属儿科医院进行。将性早熟患者随机分为训练（n=314）和验证（n=313）样本。在训练样本中，对单变量分析中与 CPP 相关的变量（P<0.2）进行多变量逻辑回归模型分析。使用逐步向前分析选择预测模型。使用模型的缩放系数构建风险评分模型，并在验证样本中进行测试。
在训练和验证样本中，分别有 54.8%（172/314）和 55.0%（172/313）的患者被诊断为 CPP。CPP 风险评分模型包括性发育开始时的年龄、基础黄体生成素（LH）浓度、最大卵巢体积和子宫体积。该模型在训练和验证样本中的 C 指数分别为 0.85（95%CI：0.81-0.89）和 0.86（95%CI：0.82-0.90）。选择两个截断点将低风险（<10 分）、中风险（10-19 分）和高风险（≥20 分）组区分开来。
CPP 风险的风险评分模型具有中等预测性能，有助于评估进一步诊断测试（GnRH 或 GnRHa 刺激试验）的需求。
