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目的评估昼夜自发性尿促性腺激素(Gn)判断儿童下丘脑-垂体-性腺轴(HPGA)启动的价值。方法 40例患儿因生长或发育异常而住院行促性腺激素释放激素类似物激发试验,激发试验前收集昼夜各12 h尿,0000血作为夜间自发性血Gn标本,激发试验0 min血作为日间自发性血Gn标本,并设健康对照(青春期前男、女童各6例)。免疫化学发光法(ICMA)检测其黄体生成素(LH)和卵泡刺激素(FSH)水平。结果 1.患儿:日间尿黄体生成素(DULH)水平、DULH/Cr和日间自发性血LH(SLH)与SLH峰值(PLH)的相关系数(r)为0.648、0.677和0.611,其判断HPGA启动的受试者工作特性曲线下面积(S)分别为0.944、0.926、0.771;夜间上述3项指标分别与PLH的r为0.651、0.638和0.656,其判断HPGA启动的S分别为0.930、0.953和0.819。2.(患儿+健康对照)52例:DULH水平、DULH/Cr、夜间尿LH(NULH)水平和NULH/Cr的判断HPGA启动的S分别为0.961、0.935、0.955和0.959;当截断值分别为DULH水平≥0.036 IU、DULH/Cr≥20.723 0 IU.mol-1、NULH水平≥0.068 IU和NULH/Cr≥34.169 1 IU.mol-1时,其判断HPGA启动的灵敏度分别为100.0%、92.3%、88.5%和88.5%,特异度分别为84.6%、88.5%、96.2%和96.2%;昼夜上述4个指标中,当任一指标判断HPGA启动的特异度达100%时,即截断值分别为DULH水平≥0.220 IU、NULH水平≥0.098IU、DULH/Cr≥163.120 7 IU.mol-1和NULH/Cr≥42.461 0 IU.mol-1时,其对应的灵敏度分别为38.5%、84.6%、11.5%和84.6%;当DULH水平≥0.036 IU且NULH水平≥0.068 IU时,其判断的特异度和灵敏度分别为100.0%和88.5%;当DULH/Cr≥20.723 0IU.mol-1且NULH/Cr≥34.169 1 IU.mol-1时,其特异度和灵敏度分别为96.2%和84.6%。结论 ICMA检测的昼夜尿Gn有助于儿童HPGA启动的判断,其价值不低于自发性血Gn,且昼夜尿Gn的联合检测可能优于其日间或夜间。
Objective To evaluate the value of diurnal nocturnal urogenital gonadotropin (Gn) in determining the initiation of hypothalamic-pituitary-gonad axis (HPGA) in children. Methods Forty patients were hospitalized with gonadotropin-releasing hormone analogue stimulation test due to abnormal growth or development. Before the test, 12 hours of urine and 0000 blood were collected as nighttime spontaneous blood Gn samples. As a daytime spontaneous blood Gn specimens, and a healthy control (pre-adolescent boys and girls each 6 cases). The levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) were detected by immunochemiluminescence (ICMA). Results 1. Children: The correlation coefficient (r) between daytime urine LH (DULH), DULH / Cr and daytime SPH and SLH was 0.648, 0.677 and 0.611, respectively The area under the working curve of HPGA-initiated subjects was 0.944, 0.926 and 0.771, respectively. The nighttime r-values of PLH and rH were 0.651, 0.638 and 0.656, respectively, and the S values of HPGA-onset were 0.930, 0.953 and 0.819.2. (Children + healthy controls) 52 cases: DULH level, DULH / Cr, nighttime urine LH (NULH) level and NULH / Cr were 0.961,0.935,0.955 and 0.959 respectively. When the cut-off values were DULH level ≥0.036 IU, DULH / Cr≥20.723 0 IU.mol-1, NULH level≥0.068 IU and NULH / Cr≥34.169 1 IU.mol-1 respectively, the sensitivities of determining HPGA start were 100%, 92.3%, 88.5% and 88.5%, specificity of 84.6%, 88.5%, 96.2% and 96.2% respectively. When the specificity of HPGA was 100% The cut-off values were respectively DULH level ≥0.220 IU, NULH level ≥0.098IU, DULH / Cr≥163.120 7 IU.mol-1 and NULH / Cr≥42.461 0 IU.mol-1, the corresponding sensitivity was 38. 5%, 84.6%, 11.5% and 84.6%, respectively. When the DULH level≥0.036 IU and the NULH level≥0.068 IU, the specificity and sensitivity of the judgment were 100.0% and 88.5% respectively. When DULH / Cr≥20.723 0IU.mol -1 and NULH / Cr≥34.169 1 IU.mol-1, the specificity and sensitivity were 96.2% and 84.6%, respectively. Conclusion The daytime and night urine Gn detected by ICMA is helpful for judging the initiation of HPGA in children, and its value is not lower than that of spontaneous blood Gn. Combined detection of diurnal urinary Gn may be better than daytime or nighttime.