| Objective:Objective to explore the clinical value of uterine and ovarian ultrasound examination combined with sex hormone test(follicle stimulating hormone FSH,luteinizing hormone LH,estradiol E2)in the diagnosis of precocious puberty in girls.Method: Through treatment for girls by gonadotropin-releasing hormone(Gn RH)stimulation test and inspection results,45 girls with idiopathic central precocious puberty(ICPP)were selected(5~8 years old,the average age 7.16 ±1.06 years old),and 45 girls with premature thelarche(PT)(5~8 years old,average age 6.65±1.12 years old).We compared the length of these two groups’ uterus,transverse diameter / anteroposterior diameter ratio of uterus,uterine volume,ovarian volume and two groups of hormone levels(estradiol,follicle stimulating hormone,luteinizing hormone)and observed whether statistical differences exist in the parameters and their sensitivity and specificity.Meanwhile,we also measure the area under the ROC curve.Results:1.Results of sex hormone examination:The group of ICPP compared with the group of PT,the average value of LH basic value,FSH basic value,E2 and LH/FSH base value in the group of ICPP were significantly higher than those in the group of PT.The average value of the ICPP group was 1.16±1.36 IU/L、4.10±1.98 IU/L、33.11±18.10 pg/ml、0.26±0.22,The average value of the PT group was 0.12±0.12IU/L、2.81±2.45IU/L、20.38±9.85 pg/ml、0.06±0.06,P<0.05,The difference determined was statistically significant.2.Ultrasound examination : The group of ICPP compared with the group of PT,the average value of the length of uterus,uterine volume and ovarian volume in the group of ICPP were significantly higher than those in the group of PT.The average value of the ICPP group was 3.08±0.87 cm、4.88±2.51 ml、2.48±1.42 ml.The average value of the PT group was 2.46±0.84 cm、1.61±0.84 ml、1.52±0.55 ml.The transverse diameter / anteroposterior diameter ratio of uterus in the group of ICPP(1.4 ± 0.39)was significantly lower than that in the group of PT(1.81 ± 0.29).The differences in uterine length,the transverse diameter / anteroposterior diameter ratio of the uterus,uterine volume and ovarian volume(P<0.05)between the both groups is statistically significant.Through the ROC curve we can analyze:1.Results of sex hormone level examination: According to the accuracy of examination,rank from high to low: LH basic value(0.90),LH/FSH basic value(0.85),E2(0.74),FSH basic value(0.72).The cut-off points for the diagnosis of ICPP of LH basic value were calculated to be 0.185IU/L,and the sensitivities and specificities were 82.2% and 86.7%.The cut-off points for FSH basic value were calculated to be 2.285IU/L,and the sensitivities and specificities were 86.7% and 60%.The cut-off points for LH / FSH basic value were calculated to be 0.065 and the sensitivities and specificities were 84.4% and 77.8%.The cut-off points for E2 were calculated to be 27.75pg/ml and the sensitivities and specificities were 57.8% and 82.2%.2.Ultrasound examination : According to the accuracy of examination,rank from high to low: uterine volume(0.89),uterine transverse diameter / anteroposterior diameter ratio(0.8),ovarian volume(0.76),and uterine long diameter(0.71).The cut-off points for the length of uterus were calculated to be 2.27 cm and the sensitivities and specificities were 88.9% and 53.3%.The cut-off points for the transverse diameter/ anteroposterior diameter ratio of uterus were calculated to be 1.56 and the sensitivities and specificities were 66.7% and 84.4%.The cut-off points for the uterine volume were calculated to be 3.095 ml and the sensitivities and specificities were 75.6% and 100%.The cut-off points for the ovary volume were calculated to be 1.95 ml and the sensitivities and specificities were 60% and 77.8%.Conclusions:1.Ultrasound examination and sex hormone examination were of major significance in identifying ICPP and PT.2.Through the analysis of ROC curve,the area under the ROC curve of LH basic value is close to the uterus volume,and the area under the ROC curve are large.It shows that they have higher diagnostic value.because the pulsatile secretion of LH,the results are influenced easily by the time of acquisition,so the diagnostic accuracy is improved by examining the sex hormone simultaneously with the ultrasound examination.3.The children with the high level of the LH basic value,LH/FSH basic value,uterine volume,and the low level of the uterine transverse diameter / diameter ratio,and after eliminating the central and surrounding tissue lesions should be considered for Idiopathic central precocious puberty.The treatment can be carried out as soon as possible,and the changes in these values can also be helpful for observation and follow-up during treatment.We should pay attention to the girls of Premature Thelarche,closely follow up so as not to delay the disease. |
PDF Full Text Request