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目的探讨促性腺激素释放激素类似物(GnRHa)激发试验时免疫化学发光分析法(ICMA)检测的无创性尿促性腺激素(UGn)可否用于儿童GnRHa的疗效判断。方法患儿23例(男4例,女19例)。中枢性性早熟17例(均为女童),予GnRHa治疗。青春期预测终身高矮小6例(男4例,女2例),予GnRHa联合生长激素治疗。在治疗前和治疗3个月均行GnRHa激发试验,留激发试验0～3.5 h尿,其中18例留取了激发试验前1 d同一时段的日间自发性尿,应用ICMA检测促黄体生成素(LH)和卵泡刺激素(FSH)。结果 1.治疗前后GnRHa激发试验时UGn显著性检验:治疗前后的尿促黄体生成素(ULH)水平分别为(1.27±1.63)IU和(0.07±0.06)IU,尿卵泡刺激素(UFSH)水平分别为(6.38±3.85)IU和(0.54±0.30)IU。2.GnRHa激发试验时血清Gn峰值和UGn对GnRHa疗效评估:当血清LH峰值(PLH)和FSH峰值(PFSH)分别≤2.30 IU.L-1和2.39 IU.L-1时,其判断疗效的灵敏度分别为95.45%和100%,特异度均为100%;当ULH水平和UFSH水平分别≤0.083 IU和1.089 IU时,其灵敏度分别为90.91%和100%,特异度均为100%。3.GnRHa激发试验时血清Gn和UGn分别与其激发试验前的比值对GnRHa疗效评估:当血清PLH/日间自发性血清LH、血清PFSH/日间自发性血清FSH分别≤5.40和2.16时,其灵敏度和特异度均为100%;当其激发试验时ULH水平/日间自发性ULH水平、激发试验时UFSH水平/日间自发性UFSH水平分别≤6.076和2.480时,其灵敏度和特异度也均达100%。结论 GnRHa激发试验时ICMA检测的无创性3.5 h UGn水平、激发试验时3.5 h UGn水平/日间自发性UGn水平指标可能对儿童GnRHa疗效具有判断价值,其中UFSH水平及其与日间自发性UFSH水平比值指标价值可能更大。
Objective To investigate whether GinRHa can be used to evaluate the efficacy of non-invasive urinary gonadotropin (UGn) detected by immunochemiluminescent assay (ICMA) in children with gnRHa. Methods 23 cases of children (4 males and 19 females). Central precocious puberty in 17 cases (all girls), to GnRHa treatment. Prediction of adolescence height-short 6 cases (4 males and 2 females), GnRHa combined with growth hormone treatment. GnRHa challenge test was performed before treatment and 3 months of treatment, leaving urinary challenge 0 ~ 3.5 h urine, of which 18 patients were taken during the same period before the challenge test 1 day spontaneous urination, ICMA detection of luteinizing hormone (LH) and follicle stimulating hormone (FSH). Results 1. The significance of UGn in GnRHa challenge test before and after treatment: (1.27 ± 1.63) IU and (0.07 ± 0.06) IU, urinary follicle stimulating hormone (UFSH) before and after treatment (6.38 ± 3.85) IU and (0.54 ± 0.30) IU, respectively. GnRHa stimulation test serum Gn peak and UGn GnRHa efficacy evaluation: when the serum LH peak (PLH) and FSH peak (PFSH) were ≤ 2.30 IU.L-1 and 2.39 IU.L-1, the judgment of efficacy The sensitivity was 95.45% and 100% respectively, and the specificity was 100%. The sensitivity was 90.91% and 100% when the level of ULH and UFSH were respectively ≤0.083 IU and 1.089 IU, the specificity was 100%. GnRHa stimulation test serum Gn and UGn, respectively, compared with its stimulation test before the GnRHa efficacy evaluation: When serum PLH / day spontaneous serum LH, serum PFSH / daytime voluntary serum FSH were 5.50 and 2.16, respectively, its Sensitivity and specificity were 100%. The sensitivity and specificity of ULH level / spontaneous ULH level during challenge test, UFSH level / spontaneous UFSH level during daytime test were respectively ≤6.076 and 2.480 Up to 100%. Conclusions The non-invasive 3.5 h UGn level detected by ICMA during GnRHa challenge test and 3.5 h UGN level / spontaneous daytime UGN level index during challenge test may be of value in evaluating the therapeutic effect of GnRHa in children. The level of UFSH and its correlation with spontaneous UFSH The ratio of the horizontal index value may be greater.