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目的探讨鉴别单纯乳房早发育(IPT)与中枢性性早熟(CPP)的快速评估方法。方法检测140例乳房早发育女童和80例健康女童[健康对照组:0～3岁30例(C1组),>3～8岁50例(C2组)]血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)基础值。对140例乳房早发育女童进行促性腺激素释放激素类似物(GnRHa)激发试验,比较70例IPT女童[0～3岁20例(IPT1组),>3～8岁50例(IPT2组)]、50例CPP(3～8岁)、20例外周性性早熟(PPP)女童血清FSH、LH激发值。采用SPSS11.0统计学软件,2组间比较采用Mann-Whitney秩和检验,多组间比较采用Kruskal-Wallis秩和检验。结果IPT1组与C1组、IPT2组和CPP组与C2比较,组间LH基础值均有显著性差异(Pa<0.05)。CPP组FSH及E2基础值与C2组比较有显著差异(Pa<0.05)。IPT2组LH/FSH比值与CPP组比较有显著性差异(P<0.05)。GnRHa激发试验后,IPT2组、CPP组与PPP组LH峰值有显著性差异(Pa<0.05)。IPT2组与CPP组FSH峰值无显著性差异(P>0.05)。IPT2组LH峰值/FSH峰值与CPP组比较有显著性差异(P<0.05)。IPT2组和CPP组中,以LH基础值>0.3IU/L作为诊断CPP界限值的灵敏度为82%,特异度为84%,假阴性率为18%,假阳性率为16%;以LH基础值/FSH基础值比值>0.2作为诊断CPP界限值的灵敏度为76%,特异度为80%,假阴性率为24%,假阳性率为20%。结论IPT是源于一种FSH占优势的分泌方式,LH基础值/FSH基础值常<0.2,GnRHa激发试验中LH峰值/FSH峰值常<0.3,而CPP则源于一种LH占优势的分泌方式,LH基础值/FSH基础值常>0.2,GnRHa激发试验中LH峰值/FSH峰值常>0.6。
Objective To explore a rapid method to identify simple early breast (IPT) and central precocious puberty (CPP). Methods 140 cases of early breast-feeding girls and 80 healthy girls were detected. [Healthy control group: 30 cases (C1 group) and 50 cases (C2 group> 3 to 8 years old) had serum follicle stimulating hormone (FSH), corpus luteum (LH), estradiol (E2) basal value. Forty girls with early breast development were challenged with gonadotropin-releasing hormone analogue (GnRHa) challenge test. Totally 70 IPT girls [IPT1 0 to 3 years old and 50 IPT2> 3 to 8 years old] were compared. , 50 cases of CPP (3 ~ 8 years old), 20 cases of peripheral precocious puberty (PPP) girls FSH and LH values. Using SPSS11.0 statistical software, Mann-Whitney rank sum test was used to compare the two groups, Kruskal-Wallis rank sum test was used to compare the multiple groups. Results Compared with C2 group, IPT2 group and CPP group, there were significant differences (P <0.05) between LH group and IPT1 group. The basal values of FSH and E2 in CPP group were significantly different from those in C2 group (Pa <0.05). The LH / FSH ratio in IPT2 group was significantly different from that in CPP group (P <0.05). After GnRHa challenge test, the peak LH values of IPT2 group, CPP group and PPP group were significantly different (Pa <0.05). IPT2 group and CPP group FSH peak no significant difference (P> 0.05). The LH peak / FSH peak in IPT2 group was significantly different from that in CPP group (P <0.05). In the IPT2 group and the CPP group, the basal LH value> 0.3 IU / L was 82%, the specificity was 84%, the false negative rate was 18% and the false positive rate was 16% The ratio of value / FSH base value> 0.2 was 76%, specificity was 80%, false negative rate was 24% and false positive rate was 20%. Conclusions IPT is derived from a predominant FSH secretion pattern, LH basal / FSH basal is often <0.2, LH peak / FSH peak is <0.3 in GnRHa provocation test, and CPP is derived from a LH-dominant secretory Mode, LH basal / FSH basal values often> 0.2, GnRHa excitation test LH peak / FSH peak often> 0.6.