摘要
目的通过超声观察及相关激素水平的检测对女性性早熟(PP)与乳房早发育(PT)患儿进行鉴别诊断,为临床诊断提供证据。方法本实验收集从2015~2016年因早期乳房增大(年龄<8岁)来笔者医院儿科就诊的女性患儿,按照诊断标准分为PP组与PT组。对所有患者进行乳房超声检查,并按照评判标准进行分级。同时检测两组间临床与各激素水平,进行组间比较。对差异性明显指标进行ROC分析。结果本研究共纳入60例女性患儿,其中PP与PT患儿分别为30例。超声乳房分级与年龄、骨龄、乳腺芽直径、LH水平、FSH水平及E_2水平呈正相关,但与骨龄和实际年龄无相关性。且PP与PT间乳房超声分级与乳房芽直径差异无统计学意义(P<0.05)。比较两组间激素水平时发现,PP组患儿的基础LH与FSH、基础LH/FSH、LF与FSH峰值与LH/FSH峰值显著高于PT组患儿(P<0.05)。用ROC分析发现LH/FSH峰值比>0.25诊断PP的敏感度为100%且特异性为85%,基础LH>0.1的敏感度为72%且特异性为65%。两组间SHBG水平是唯一没有重叠的指标[PP:80.6(62.3~95.4)vs PT:114.5(107.6~121.5)]。kisspeptin、leptin与neurokinin B在两组间比较,差异无统计学意义(P>0.05)。结论乳房超声检查通过分级与乳房芽测量可有效评估女性性早熟患儿的乳房发育水平,但并不能鉴别PP与PT。研究发现SHBG浓度及LH/FSH峰值比可有效鉴别PP与PT,但kisspeptin、neurokinin B与leptin不足以鉴别PP与PT。
Objective The differential diagnosis of female precocious puberty （PP） and premature breast development （PT） was made by ultrasound and related hormone levels, so as to provide the basis for clinical diagnosis. Methods In this study, from 2015 to 2016 due to early breast enlargement （age 〈 8 years） to our hospital pediatric patients with children, according to the diagnostic criteria were divided into PP group and PT group. Ultrasonography was performed on all patients and graded according to the criteria. At the same time, the levels of clinical and hormones were compared between the two groups. ROC analysis was used to identify the significant differ- ences. Results In this study, a total of 60 cases of female children, including PP and PT children were 30 cases. Ultrasonic breast grad- ing was positively correlated with age, BA, BD, LH level, FSH level and E2 level, but there was no correlation between BA/CA. There was no statistical difference between the breast ultrasound and the breast diameter （ P 〈 0.05 ）. The levels of LH and FSH, basal LH/ FSH, LF and FSH peak and LH/FSH peak in the PP group were significantly higher than those in the PT group （ P 〈 0.05）. The ROC a- nalysis found 100% sensitivity and 85% specificity for LH/FSH peak 〉 O. 25 for diagnosis of PP, with a 72% sensitivity and a specificity of 65% for basal LH 〉0. lmIU/ml. The SHBG level was the only one that did not overlap [PP： 80.6 （62.3 -95.4） vs PT： 114.5 （107.6- 121.5）]. There was no significant difference in kisspeptin, leptin and neurokinin B between the two groups （P 〉 0.05）. Conclusion Breast ultrasound by grading and measurement of breast buds can be effective in evaluating the development of female preco- cious puberty breast development, but can not identify PP and PT. The study found that SHBG concentration and peak ratio of LH/FSH can effectively identify PP and PT, but kisspeptin, neurokinin B and leptin is not enough to identify PP and PT.
作者
张婧
张晓
邓巍
Zhang Qian Zhang Xiao Deng Wei.(Department of Pediatrics,Renmin Hospital of Wuhan University, Hubei 430060, Chin)
出处
《医学研究杂志》
2017年第7期121-125,共5页
Journal of Medical Research
关键词
性早熟
乳房早发育
超声检查
性激素
神经肽
Precocious puberty
Premature thelarche
Ultrasonography
Sex hormone
Neuropeptide
