目的： 探寻临床鉴别慢进展型中枢性性早熟（slowly progressive central precocious puberty, SP-CPP）与快进展型中枢性性早熟（rapidly progressive central precocious puberty, RP-CPP）的方法。方法： 收集8岁前出现乳房发育的女童,行促黄体素释放素（lutropin hormone releasing hormone, LHRH）激发试验,定量检测血促黄体素（lutropin hormone, LH）、卵泡刺激素（follicle-stimulating hormone, FSH）,同时采用定量试剂盒测定晨尿中LH和FSH。受检测者中53例被诊断为中枢性性早熟（central precocious puberty,CPP）。随访半年后观察其发育进展情况（生长速率、骨龄及第二性征发育等）,分为SP-CPP（30例）和RP-CPP（23例）2组,比较分析2组间初诊时血和尿的LH、FSH以及相关参数的差异。结果： 初诊血LH峰值、血LH 峰值/FSH峰值比（以下简称LH/FSH峰值比）及晨尿FSH水平在鉴别SP-CPP与RP-CPP中有一定的临床应用价值,而晨尿LH及晨尿LH/晨尿FSH比值在2组间差异均无统计学意义。与SP-CPP组相比,RP-CPP组具有较高的血LH峰值[（18.06±3.68）IU/L比（7.58±2.50）IU/L,P<0.001]和LH/FSH峰值比[1.67±1.08比0.97±0.43,P=0.014],而其晨尿FSH则低于SP-CPP组[（4.34±1.52）IU/L比（7.60±1.20）IU/L, P=0.007]。根据受试者操作特征曲线（receiver operator characteristic curve,ROC曲线）分析,血LH峰值的临界值为9.68 IU/L时,大于等于该值时鉴别RP-CPP与SP-CPP的灵敏度为76.9%,特异度为87.0%;血LH/FSH峰值比的临界值为1.24,大于等于该值时,其鉴别两者的灵敏度为69.2%,特异度为73.9%;晨尿FSH的临界值为5.91 IU/L,大于等于该值时,其鉴别两者的灵敏度（76.9%）及特异度（78.3%）与血指标检测结果相似。结论： 测定晨尿促性腺激素是一种无创且较可靠的方法,初诊时检测晨尿FSH,对早期CPP分型诊断有一定的辅助意义。

Objective: To explore a approach of differentiating rapidly progressive central precocious puberty (RP-CPP) from slowly progressive central precocious puberty(SP-CPP) in girls. Methods: Girls showing breast development before 8-year-old were enrolled. On the first visit, the lutropin hormone（LH） and follicle-stimulating hormone（FSH） in serum were quantitatively detected by lutropin hormone releasing hormone（LHRH） stimulating test, LH and FSH in urine were tested by quantitative determination Kits. Among enrolled girls, fifty-three were diagnosed as central precocious puberty (CPP). The patients were divided into SP-CPP (30 girls) and RP-CPP (23 girls) groups after 6 month-follow-up for pubertal advancement, height acceleration, and bone age maturation. The levels of LH and FSH in serum and urine as well as related parameters were compared between RP-CPP and SP-CPP groups. Results: Serum LH peak, the ratio of LH peak/FSH peak (the ratio of LH/FSH peak) and urinary FSH(UFSH) level showed reference value in differentiating RP-CPP from SP-CPP, While morning urinary LH (ULH) and urinary FH/FSH ratio were not different between RP-CPP and SP-CPP girls. Compared with SP-CPP subjects, RP-PP ones had significantly increased serum LH peak [（18.06±3.68） IU/L vs. (7.58±2.50） IU/L, P<0.001] and serum LH/FSH peak ratio（1.67±1.08 vs. 0.97±0.43, P=0.014） and decreased UFSH[（4.34±1.52） IU/L vs. 7.60±1.20）IU/L, P=0.007]. The diagnostic efficacy of indices mentioned above were assessed with receiver operator characteristic （ROC） curve. It showed that the sensitivity and specificity of serum LH peak (cutoff 9.68 IU/L) for differentiating RP-CPP from SP-CPP were 76.9% and 87.0% respectively, and serum LH/FSH peak ratio (cutoff value 1.24) were 69.2% and 73.9%. Morning UFSH （cutoff value 5.91 IU/L）for prospectively diagnosing RP-CPP had a sensitivity of 76.9% and a specificity of 78.3%, which had similar efficacy as serum LH peak and serum LH/FSH peak ratio. Conclusions: Quantitative measurement of morning voided urinary gonadotropin is a noninvasive and reliable approach to diagnose RP-CPP prospectively, and UFSH measurement on the first visit has reference value in prospective diagnosis.