背景:探讨COVID-19大流行期间6~8岁女孩特发性早熟(IPT)和中枢性性早熟(CPP)的鉴别诊断。我们探索了预测的成人身高(PAH)差异,以指导适当的诊断和治疗。
方法:从2020年1月至2021年12月,招募6至8岁性早熟的中国女孩。分为IPT组和CPP组。临床特征,包括高度,体重,体重指数(BMI),基础黄体生成素(LH),雌二醇,子宫长度和体积,记录卵泡数(d>4mm)和骨龄(BA)。我们分析了两组的鉴别诊断和PAH差异。采用二元logistic回归分析探讨CPP的危险因素。并生成受试者工作特征(ROC)曲线,评价相关指标的诊断价值。
结果:60名患者,包括40名IPT女孩和20名CPP女孩,被招募。整个队列中超重和肥胖的患病率为25%(15/60),IPT明显高于CPP,32.5%(13/40)与10%(2/20),分别为(P=0.045)。LH有显著差异,子宫体积,卵泡数和BA(P<0.05)。IPT和CPP的PAH分别为0.01±1.19SD和0.62±0.94SD,差异有统计学意义(P=0.047)。Logistic回归分析显示LH和卵泡数是CPP的独立危险因素。ROC曲线显示LH和卵泡数的曲线下面积(AUC)分别为0.823和0.697。截断值为0.285IU/L的LH的敏感性和特异性分别为78.9%和77.8%。截断率为3.5的卵泡数的敏感性和特异性分别为89.5%和52.8%。
结论:6-8岁性早熟女孩超重和肥胖的患病率较高。辅助数据不应用于IPT和CPP的鉴别诊断。高于0.285IU/L的基础LH和大于4的卵泡数是提示CPP的重要特征。CPP患者PAH受损,但在IPT患者中并未受损。
To investigate the differential diagnosis of girls aged 6 to 8 years with idiopathic premature thelarche (IPT) and central precocious puberty (CPP) during the COVID-19 pandemic. We explored predicted adult height (PAH) discrepancy to guide appropriate diagnosis and treatment.
From January 2020 to December 2021, Chinese girls aged 6 to 8 years with precocious puberty were recruited. They were divided into IPT and CPP groups. Clinical characteristics, including height, weight, body mass index (BMI), basal luteinizing hormone (
LH), oestradiol, uterine length and volume, follicle numbers (d > 4 mm) and bone age (BA) were recorded. We analysed differential diagnosis and PAH discrepancy in both groups. Binary logistic regression analysis was used to explore risk factors for CPP, and receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic value of related indexes.
Sixty patients, including 40 girls with IPT and 20 girls with CPP, were recruited. The prevalence of overweight and obesity in the entire cohort was 25% (15/60) and was significantly higher in IPT than CPP, 32.5% (13/40) vs. 10% (2/20), respectively (P=0.045). There were significant differences in
LH, uterine volume, follicle numbers and BA (P<0.05). The impaired PAH of IPT and CPP was 0.01 ± 1.19 SD and 0.62 ± 0.94 SD with significant differences (P=0.047). Logistic regression analysis showed that
LH and follicle numbers were independent risk factors for CPP. The ROC curve showed that the area under the curve (AUC) of LH and follicle numbers were 0.823 and 0.697. The sensitivity and specificity of
LH with a cut off of 0.285 IU/L were 78.9% and 77.8%. The sensitivity and specificity of follicle numbers with a cut off of 3.5 were 89.5% and 52.8%.
The prevalence of overweight and obesity in 6- to 8-year-old girls with precocious puberty was high. Auxological data should not be used in the differential diagnosis of IPT and CPP. Basal
LH above 0.285 IU/L and follicle numbers greater than 4 were important features suggestive of CPP. PAH was impaired in individuals with CPP, but it was not impaired in individuals with IPT.