The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
J Clin Endocrinol Metab. 2021 Oct 21;106(11):e4520-e4530. doi: 10.1210/clinem/dgab448.
Although gonadotropin-releasing hormone stimulation test (GnRHST) is the gold standard in diagnosing central precocious puberty (CPP), it is invasive, expensive, and time-consuming, requiring multiple blood samples to measure gonadotropin levels.
We evaluated whether urinary hormones could be potential biomarkers for prepuberty or postpuberty, aiming to simplify the current diagnosis and prognosis procedure.
We performed a cross-sectional study of a total of 355 girls with CPP in National Clinical Research Center for Child Health in China, including 258 girls with positive and 97 girls with negative results from GnRHST. Twenty patients received GnRH analogue (GnRHa) treatment and completed a 6-month follow up. We measured luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, prolactin, progesterone, testosterone, and human chorionic gonadotropin in the first morning voided urine samples.
Their urinary LH levels and the ratios of LH to FSH increased significantly with the advancement in Tanner stages. uLH levels were positively associated with basal and peak LH levels in the serum after GnRH stimulation. A cutoff value of 1.74 IU/L for uLH reached a sensitivity of 69.4% and a specificity of 75.3% in predicting a positive GnRHST result. For the combined threshold (uLH ≥ 1.74 + uLH-to-uFSH ratio > 0.4), the specificity reached 86.6%. After 3 months of GnRHa therapy, the uLH and uFSH levels decreased accordingly.
uLH could be a reliable biomarker for initial CPP diagnosis and screening; uLH could also be an effective marker for evaluating the efficacy of clinical treatment.
虽然促性腺激素释放激素刺激试验（GnRHST）是诊断中枢性性早熟（CPP）的金标准，但它具有侵袭性、昂贵且耗时，需要多次采集血液样本来测量促性腺激素水平。
我们评估了尿激素是否可以作为青春期前或青春期后的潜在生物标志物，旨在简化当前的诊断和预后程序。
我们在中国国家儿童健康临床医学研究中心进行了一项总计 355 例 CPP 女孩的横断面研究，包括 258 例 GnRHST 阳性和 97 例 GnRHST 阴性的女孩。20 例患者接受了促性腺激素释放激素类似物（GnRHa）治疗，并完成了 6 个月的随访。我们测量了晨尿样本中的黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇、催乳素、孕酮、睾酮和人绒毛膜促性腺激素。
她们的尿 LH 水平和 LH 与 FSH 的比值随着 Tanner 分期的进展显著升高。uLH 水平与 GnRH 刺激后血清中的基础和峰值 LH 水平呈正相关。uLH 的截断值为 1.74IU/L 时，预测 GnRHST 阳性结果的敏感性为 69.4%，特异性为 75.3%。对于联合阈值（uLH≥1.74+uLH-to-uFSH 比值>0.4），特异性达到 86.6%。GnRHa 治疗 3 个月后，uLH 和 uFSH 水平相应下降。
uLH 可作为 CPP 初始诊断和筛查的可靠生物标志物；uLH 也可作为评估临床治疗效果的有效标志物。
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