尿促性腺激素全定量测定在预测女童乳房早发育类型中的应用价值

doi:10.16150/j.1671-2870.2019.03.009

诊断学理论与实践 ›› 2019, Vol. 18 ›› Issue (03): 291-295.doi: 10.16150/j.1671-2870.2019.03.009

尿促性腺激素全定量测定在预测女童乳房早发育类型中的应用价值

马晓宇¹, 陆文丽¹(), 倪继红¹, 王俊琪¹, 陈烨², 秦雪艳¹, 董治亚¹, 王伟¹

1.上海交通大学医学院附属瑞金医院儿内科, 上海 200025
2.上海交通大学医学院附属瑞金医院北院儿内科, 上海 201821

收稿日期:2019-03-20 出版日期:2019-06-25 发布日期:2019-06-25
通讯作者: 陆文丽 E-mail:179788825@qq.com
基金资助:
上海市科委重大项目(12411950400)

Value of quantitative assay of urinary LH and FSH in differentiating classic from transitional premature thelarche

MA Xiaoyu¹, LU Wenli¹(), NI Jihong¹, WANG Junqi¹, CHEN Ye², Qin Xueyan¹, DONG Zhiya¹, WANG Wei¹

1. Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200025, China
2. Department of Pediatrics, North Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai201821, China

Received:2019-03-20 Online:2019-06-25 Published:2019-06-25
Contact: LU Wenli E-mail:179788825@qq.com

摘要/Abstract

摘要：

目的： 探讨晨尿黄体生成素(luteinizing hormone, LH)、卵泡刺激素(follicle stimulating hormone, FSH)全定量测定在鉴别经典型与过渡型乳房早发育中的应用价值。方法： 对112例8岁前出现乳房发育的女童初诊时进行促黄体生成素释放激素（luteinizing hormone releasing hormone,LHRH）激发试验及尿LH、FSH全定量测定,其中53例诊断为中枢性性早熟,49例诊断为单纯乳房早发育（premature thelarche,PT）。对PT患儿随访半年后观察其青春发育进展情况（性激素水平、生长速率、骨龄及第二性征发育等）,并将其分为经典组（24例）和过渡组（25例）,比较初诊时血、尿LH水平与FSH水平间的相关性及相关参数的差异,用受试者工作特征曲线预测效能。结果： 2组患儿血清LH水平与其晨尿LH水平呈正相关,在经典型和过渡型PT患儿的初诊时晨尿LH/FSH比值分别为0.50±0.35和 1.16±1.08,2组间差异有统计学意义（P<0.05）。受试者工作特征曲线更一步证实了尿LH/FSH比值在鉴别经典型与过渡型PT中的优越性,其预测灵敏度为80%,特异度为55.6%。结论： 采用全定量测定法来检测晨尿促性腺激素以替代采血具有较高的诊断准确率、简便性及可重复性,初诊时晨尿LH/FSH比值是一种无创、可靠的鉴别经典型与过渡型PT的方法,对早期预测PT转化为CPP具有一定临床意义。

关键词: 乳房早发育, 尿黄体生成素, 尿卵泡刺激素

Abstract:

Objective: To investigate the value of quantitative assay of urinary FSH and LH in differentiating classic from transitional premature thelarche. Methods: A total of 112 girls with breast development before 8 years of age and undergone both LHRH stimulation and urinary LH and urinary UFSH assay were enrolled. Of them 53 girls with CPP (central precocious puberty) started treatment immediately, whereas the other 49 girls were observed 6 months for pubertal advancement, gonadal hormone, height acceleration, and bone age maturation, and were categorized into two groups: the classic premature thelarche group and the transitional premature thelarche group. Results: In both groups, the serum LH level was positively correlated with morning urinary LH level. The morning urinary LH/FSH of girls at first visit in classic premature thelarche and transitional premature thelarche were 0.50±0.35 and 1.16±1.08, respectively, the difference was statistically significant (P<0.05). Urinary LH/FSH could differentiate girls with classic premature thelarche from transitional premature thelarche. Receiver operating characteristics analysis showed an LH/FSH cutoff value of 0.512, sensitivity of 80% and specificity of 56%. Conclusions: Urinary LH/FSH assay is a noninvasive, reliable method that can assist the differentiation between classic from transitional premature thelarche.

Key words: Premature thelarche, Urinary luteintizing honmone, Urinary follicle stimulating hormone

中图分类号:

R725.8

马晓宇, 陆文丽, 倪继红, 王俊琪, 陈烨, 秦雪艳, 董治亚, 王伟. 尿促性腺激素全定量测定在预测女童乳房早发育类型中的应用价值[J]. 诊断学理论与实践, 2019, 18(03): 291-295.

MA Xiaoyu, LU Wenli, NI Jihong, WANG Junqi, CHEN Ye, Qin Xueyan, DONG Zhiya, WANG Wei. Value of quantitative assay of urinary LH and FSH in differentiating classic from transitional premature thelarche[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 291-295.

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参考文献 11

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项目	经典型PT	过渡型PT	P值
血LH基值（IU/L）	0.14±0.05	0.17±0.04	0.57
血LH峰值（IU/L）	2.67±1.59	3.14±1.29	0.35
血FSH基值（IU/L）	1.48±0.67	2.02±1.23	0.06
血FSH峰值（IU/L）	10.45±6.93	10.50±5.04	0.97
血LH/FSH峰值比值	0.38±0.12	0.39±0.11	0.93
晨尿LH（IU/L）	1.30±0.27	2.35±0.99	0.12
晨尿FSH（IU/L）	3.45±1.20	2.78±1.52	0.49
晨尿LH/FSH比值半年后血LH峰值（IU/L）半年后血FSH峰值（IU/L）	0.50±0.35 2.56±1.09 10.43±5.50	1.16±1.08 5.75±0.49 8.26±0.88	0.02 <0.01 0.10

项目	经典型（n=24）	过渡型（n=25）
乳房发育年龄（岁）	5.68±1.60	6.14±1.51
入院检查年龄（岁）	6.11±1.11	6.76±1.02
骨龄 (岁)	6.01±1.80	7.91±1.52
身高标准差积分	0.66±0.33	1.02±0.71
体质量指数（kg/m²）	12.80±2.64	16.00±2.22

项目	晨尿LH/FSH	血清LH/FSH 峰值比值	血清LH峰值
最佳临界值	≥0.512	≥0.290	≥0.596
ROC曲线下面积	0.722	0.640	0.596
灵敏度	80.0%	60.0%	53.3%
特异度	55.6%	73.2%	73.2%

尿促性腺激素全定量测定在预测女童乳房早发育类型中的应用价值

Value of quantitative assay of urinary LH and FSH in differentiating classic from transitional premature thelarche

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