促性腺激素释放激素短时间刺激试验在中枢性性早熟诊断中的应用。
A Short-Duration Gonadotropin-Releasing Hormone Stimulation Test for the Diagnosis of Central Precocious Puberty.
机构信息
Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34129 Trieste, Italy.
Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy.
出版信息
Medicina (Kaunas). 2023 Dec 22;60(1):24. doi: 10.3390/medicina60010024.
: The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard method for diagnosing central precocious puberty (CPP), although it requires multiple blood samplings over 120 min. This study aimed to evaluate if a shorter test may have an equivalent diagnostic accuracy. : We retrospectively reviewed the GnRH tests of 188 consecutive pediatric patients (169 females) referred for signs of early pubertal development. The diagnostic accuracy of the hormonal levels was evaluated at different time points (15, 0, 60, 90, and 120 min after the GnRH stimulus). A diagnosis of CPP was made in 130 cases (69%), with 111 (85%) being female. Sensitivity and specificity ratings higher than 99% for the diagnosis of CPP were achieved for LH levels ≥4.7 mU/mL at 30 and 60 min after the stimulus (area under the ROC curve (AUC) = 1), with no further increase in the diagnostic accuracy in the remaining time points. No sex differences in diagnostic accuracy were found. The LH/FSH ratio at 30 min showed a sensitivity of 94.9%, with an AUC of 0.997 and a value ≥0.76. A short-duration GnRH test of 60 min provided optimal results for the diagnosis of CPP. Extending the test for an extra hour is therefore unnecessary and inadvisable.
促性腺激素释放激素（GnRH）刺激试验是诊断中枢性性早熟（CPP）的金标准方法，尽管它需要在 120 分钟内多次采血。本研究旨在评估较短的测试是否具有等效的诊断准确性。
我们回顾性分析了 188 例连续儿科患者（169 例女性）的 GnRH 测试结果，这些患者因早期青春期发育迹象而就诊。在不同时间点（GnRH 刺激后 15、0、60、90 和 120 分钟）评估激素水平的诊断准确性。130 例（69%）诊断为 CPP，其中 111 例（85%）为女性。LH 水平≥4.7 mU/mL 在刺激后 30 和 60 分钟时对 CPP 的诊断具有超过 99%的敏感性和特异性评分（ROC 曲线下面积（AUC）=1），在其余时间点，诊断准确性没有进一步提高。性别对诊断准确性没有影响。LH/FSH 比值在 30 分钟时的敏感性为 94.9%，AUC 为 0.997，且值≥0.76。60 分钟的 GnRH 短程测试对 CPP 的诊断提供了最佳结果。因此，延长测试时间额外一小时是不必要和不可取的。
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