Neely E K, Hintz R L, Wilson D M, Lee P A, Gautier T, Argente J, Stene M
Department of Pediatrics, Stanford University, CA 94305, USA.
J Pediatr. 1995 Jul;127(1):40-6. doi: 10.1016/s0022-3476(95)70254-7.
We sought to establish normative data for spontaneous and gonadotropin-releasing hormone (GnRH)-stimulated serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels measured by new immunochemiluminometric assays (ICMA) in children and adolescents.
Random serum samples were obtained from 375 normal subjects (0.1 to 17.7 years, 230 female subjects). Intravenous GnRH stimulation tests were performed in 41 normal subjects (4.8 to 18 years, 20 female subjects). Normal ranges were calculated by age and Tanner stage. Immunochemiluminometric assays of LH and FSH concentrations were compared with levels obtained by a sensitive immunofluorometric assay and a less sensitive radioimmunoassay.
Random gonadotropin concentrations in normal children followed the pattern of transient elevation in infancy, low but measurable prepubertal levels, and markedly increased values at puberty. Spontaneous LH levels were higher in male infants but were not statistically different in boys and girls after infancy. Mean prepubertal LH was 0.04 +/- 0.04 IU/L (n = 66), rising 100-fold during puberty. Spontaneous FSH levels were much higher than LH values, were higher in female infants, and rose threefold at puberty. Peak GnRH-stimulated LH was identical in prepubertal boys and girls (1.8 +/- 1.3 IU/L, n = 17) and increased 20-fold at puberty. Mean peak GnRH-stimulated FSH was highest in prepubertal female subjects. Luteinizing hormone values measured by ICMA and immunofluorometric assay were highly correlated, but radioimmunoassay levels diverged markedly from ICMA levels at lower concentrations. Because absolute levels were higher, FSH values correlated adequately in the three assays throughout the normal physiologic range.
Measurement of LH by ICMA is much more sensitive than older assay methods. Spontaneous LH can be accurately measured by ICMA to the very low levels present in normal prepubertal children, providing a potentially important biochemical discriminator of pubertal status. An ICMA GnRH-stimulated LH level greater than 5 IU/L is suggestive of maturing gonadotropin secretion. The ICMA LH assays provide significant enhancement in sensitivity; these assays should be used when levels may be low, and by their accuracy may reduce the time and expense of testing procedures.
我们试图建立通过新型免疫化学发光分析法（ICMA）测定的儿童和青少年血清促黄体生成素（LH）及促卵泡生成素（FSH）的自发分泌水平和促性腺激素释放激素（GnRH）刺激后水平的正常参考数据。
从375名正常受试者（年龄0.1至17.7岁，其中女性受试者230名）中采集随机血清样本。对41名正常受试者（年龄4.8至18岁，其中女性受试者20名）进行静脉GnRH刺激试验。根据年龄和 Tanner 分期计算正常范围。将LH和FSH浓度的免疫化学发光分析法与通过敏感免疫荧光分析法和不太敏感的放射免疫分析法获得的水平进行比较。
正常儿童的随机促性腺激素浓度呈现出婴儿期短暂升高、青春期前水平低但可测、青春期显著升高的模式。男性婴儿的自发LH水平较高，但婴儿期后男孩和女孩之间无统计学差异。青春期前LH平均水平为0.04±0.04 IU/L（n = 66），青春期升高100倍。自发FSH水平远高于LH值，女性婴儿中更高，青春期升高三倍。青春期前男孩和女孩GnRH刺激后的LH峰值相同（1.8±1.3 IU/L，n = 17），青春期升高20倍。青春期前女性受试者GnRH刺激后的FSH平均峰值最高。通过ICMA和免疫荧光分析法测定的LH值高度相关，但放射免疫分析法在较低浓度时的水平与ICMA水平明显不同。由于绝对水平较高，FSH值在整个正常生理范围内的三种分析方法中相关性良好。
通过ICMA测定LH比旧的分析方法更敏感。ICMA能够准确测量正常青春期前儿童极低水平的自发LH，这是青春期状态潜在的重要生化判别指标。ICMA GnRH刺激后的LH水平大于5 IU/L提示促性腺激素分泌成熟。ICMA LH分析方法显著提高了灵敏度；当水平可能较低时应使用这些方法，且因其准确性可减少检测程序的时间和费用。
