摘要
目的 本研究旨在探讨乳腺、盆腔超声联合血清性激素:卵泡刺激素(FSH)、黄体生成素(LH)、LH峰值/FSH峰值及雌二醇(E2)等多参数对女童中枢性性早熟诊断价值的研究.方法 选取了在2022年1月至2023年12月期间就诊于龙岗中心医院、进行了促性腺激素释放激素(GnRH)激发试验的中枢性性早熟(CPP)(平均年龄(7.00±1.27)岁)65例作为病例组,同时选取了健康女童(平均年龄(6.53±1.11)岁)53例作为对照组.比较两组乳腺超声Tanner分期、子宫体积、卵巢体积、直径大于4mm卵泡个数、平均值、卵泡总体积、卵泡总体积与卵巢体积比以及血清性激素是否具有统计学差异,并测量其ROC曲线下的面积.分析乳腺、盆腔超声联合性激素水平对CPP诊断、探讨多参数联合诊断的准确性、灵敏度和特异度.结果 CPP组乳腺超声Tanner(B Tanner)分期的秩均值(65.67)、子宫体积[(2014.56±1355.11)mL]、单侧卵巢体积[(4.55±5.21)mL]、单侧直径大于4mm卵泡平均值[(0.61±0.75)mm]、单侧卵泡总体积[(1.0±2.96)mL]、单侧卵泡总体积与卵巢体积比[0.53±2.48)mL]、FSH[(2.41±1.37)mIU/L]、LH[(0.45±0.98)mIU/L]、LH 峰值/FSH 峰值[(0.22±0.39)]和 E2(53.32)阳性的秩均值均高于对照组B Tanner分期的秩均值(50.66)、子宫体积[(1415.99±799.22)mL]、单侧卵巢体积[(4.55±5.21)mL]、单侧直径大于4mm卵泡平均值[(0.43±0.14)mm]、单侧卵泡总体积[(0.48±0.41)mL]、单侧卵泡总体积与卵巢体积比[0.17±0.11)mL]、FSH[(1.88±0.82)mIU/L]、LH[(2.24±1.37)mIU/L]、LH 峰值/FSH 峰值[(0.05±0.09)]和E2(38.63)均有统计学意义(P＜0.05),而直径大于4mm卵泡个数无统计学差异.由于卵巢有双侧,且卵巢参数较多,使用二元Logistic回归方法得到卵巢多参数回归值,Logistic回归分析显示B Tanner分期、卵巢多参数回归值、FSH是CPP的独立危险因素(P＜0.05).ROC曲线结果显示,B Tanner分期、卵巢多参数回归值、血清性激素联合监测诊断女童中枢性性早熟的AUC(曲线下面积)分别为0.628、0.795、0.927,联合诊断效能最高,B Tanner分期、卵巢多参数回归值、血清性激素三者联合检测CPP的AUC(0.946)高于B Tanner分期联合卵巢多参数回归值(0.837)或B Tanner分期联合性激素检测(0.897)(P＜0.05),其灵敏度和特异度分别为95.7％、75.0％.结论 B Tanner分期、卵巢多参数回归值及血清性激素联合监测诊断女童中枢性性早熟的灵敏度及特异度均高于单一诊断,值得临床推广.综上所述,B Tanner分期、卵巢多参数回归值、血清性激素三者联合可有效甄别CPP,可作为常规的筛查手段,具有无创、无辐射、便捷等优势.
Abstract
Objective The purpose of this study was to investigate the diagnostic value of breast and pelvic ultrasound combined with serum sex hormones such as Follicle Stimulating Hormone(FSH),Luteinizing Hormone(LH),LH peak/FSH peak and Estradiol(E2)in Central Precocious Puberty in girls.Methods A total of 65 patients with Central Precocious Pu-berty(CPP)(mean age(7.00±1.27)years)who were admitted to Longgang Central Hospital from January 2022 to Decem-ber 2023 and underwent GnRH stimulation test were selected as a case group.Meanwhile,53 healthy girls(mean age(6.53±1.11)years)were selected as control group.The Tanner stage,uterine volume,ovarian volume,number of follicles with diameter greater than 4mm,average value,total follicle volume,ratio of total follicle volume to ovarian volume,and ser-um sex hormone were compared between the two groups,and the area under the ROC curve was measured.To analyze the accuracy,sensitivity and specificity of breast and pelvic ultrasound combined with sex hormone levels in the diagnosis of CPP.Results CPP Breast ultrasound Tanner(B Mean rank of Tanner stage(65.67),uterine volume[(2014.56±1355.11)mL],unilateral ovarian volume[(4.55±5.21)mL],mean value of follicles with a diameter greater than 4mm[(0.61±0.75)mm],total volume of unilateral follicles[(1.0±2.96)mL]The mean rank of FSH[(2.41±1.37)mIU/L],LH[(0.45±0.98)mIU/L],LH peak/FSH peak[(0.22±0.39)]and E2(53.32)positive were higher than those in control group B The mean rank of Tanner stage(50.66),uterine volume[(1415.99±799.22)mL],unilateral ovarian vol-ume[(4.55±5.21)mL],mean value of follicles with a diameter greater than 4mm[(0.43±0.14)mm],total volume of u-nilateral follicles[(0.48±0.41)mL],The ratio of total follicular volume to ovarian volume[0.17±0.1 1)mL],FSH[(1.88±0.82)mIU/L],LH[(2.24±1.37)mIU/L],LH peak/FSH peak[(0.05±0.09)]and E2(38.63)were statisti-cally significant(P＜0.05).There was no significant difference in the number of follicles larger than 4mm in diameter.Due to the bilateral ovary and the large number of ovarian parameters,the multiple parameter regression values of the ovary were obtained by binary Logistic regression method.Logistic regression analysis showed that the B Tanner stage,the multiple pa-rameter regression value of the ovary and FSH were independent risk factors for CPP(P＜0.05).ROC curve results showed that the AUC(area under the curve)of B Tanner staging,ovarian multi-parameter regression value and serum sex hormone combined monitoring for the diagnosis of Central Precocious Puberty in girls were 0.628,0.795 and 0.927,respectively,in-dicating the highest diagnostic efficacy.The AUC of CPP measured by the combination of B Tanner stage,ovarian multipa-rameter regression value and serum sex hormone(0.946)was higher than that of B Tanner stage combined with ovarian mul-tiparameter regression value(0.837)or B Tanner stage combined with sex hormone detection(0.897)(P＜0.05).The sen-sitivity and specificity were 95.7％and 75.0％,respectively.Conclusion The sensitivity and specificity of B Tanner stag-ing,ovarian multi-parameter regression and serum sex hormone combined monitoring in the diagnosis of Central Precocious Puberty in girls are higher than that of single diagnosis,which is worthy of clinical promotion.In summary,the combination of B Tanner staging,ovarian multi-parameter regression value and serum sex hormone can effectively screen CPP,and can be used as a routine screening method,which has the advantages of non-invasive,non-radiation and convenient.
维普
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