促性腺激素释放激素兴奋试验对性发育疾病的诊断价值

发布时间：2018-03-02 01:20

本文关键词： GnRH CPP IHH Kallmann综合征 CDP　出处：《南开大学》2012年硕士论文　论文类型：学位论文

【摘要】：研究背景与目的：促性腺激素释放激素(GnRH)兴奋试验是通过GnRH类似物(戈那瑞林等)兴奋垂体分泌黄体生成素(LH)和卵泡刺激素(FSH)来评价垂体促性腺激素细胞的储备功能以及下丘脑-垂体-性腺(HPG)轴兴奋状态的一种常用试验方法。目前广泛应用于中枢性性早熟(CPP)、特发性低促性腺激素性性腺功能减退(IHH)、Kallmann综合征(KS)、体质性青春期延迟(CDP)等多种性发育疾病的诊断。但虽然在临床上的应用已近30年,其诊断指标的选择及诊断切割值仍不十分明确,诊断价值亦存在一定争议。本研究通过对不同性发育疾病患者与正常青春期前期及成年人的比较,探讨了GnRH兴奋试验在CPP、IHH、KS、CDP疾病诊断及鉴别中的最佳诊断指标及切割值和诊断价值。方法：对确诊为CPP(15例),IHH(65例)、KS(31例)、CDP(27例)患者行GnRH兴奋试验时LH和FSH的变化进行回顾性分析,并与青春期前期儿童(6例)及正常成年志愿者(20例)行GnRH兴奋试验时LH、FSH的变化进行比较,通过绘制受试者工作曲线(ROC)探讨了适宜的诊断指标及切割值并评价了诊断价值的高低。结果：1、鉴别诊断CPP组与青春期未启动者组(包括正常青春期前期儿童、IHH及KS)宜综合考虑FSH峰值和LH峰值,切割值为预测概率0.93,诊断的敏感度为93.3%,特异性为71.3%(排除性别因素)；2、对于女性CPP组与青春期未启动组(包括正常青春期前期儿童、IHH及KS)的鉴别宜采用LH峰值,切割值为LH峰值6.77IU/L,诊断敏感度为92.3%,特异性为70.0%；3、鉴别诊断HH组(包括IHH与KS)与CDP组宜采用LH峰值,切割值为LH峰值9.74IU/L,诊断敏感度为77.5%,特异性为85.2%(排除性别因素)；4、对于男性HH组与CDP组的鉴别也宜采用LH峰值,最佳切割值也为LH峰值9.74IU/L,诊断敏感性为77.2%,特异性为87.0%。结论：GnRH兴奋试验对于多种性发育疾病的诊断与鉴别均具有一定的作用,在CPP的诊断与鉴别中诊断价值高,其评价宜综合分析LH峰值及FSH峰值；在HH与CDP的诊断与鉴别中其诊断价值则为中等,临床上不宜单纯依赖GnRH试验来鉴别HH与CDP。
[Abstract]:Background & AIM: gonadotropin releasing hormone (GnRH) stimulation test is to evaluate the reserve of pituitary gonadotropin cells by stimulating pituitary secretion of luteinizing hormone (LHH) and follicle stimulating hormone (FSH) by GnRH analogues (Gonarelin et al.). A common test method for the function and the excitatory state of hypothalamus-pituitary-gonadal HPGs axis is widely used in central precocious puberty, idiopathic hypogonadotropic gonadotropin hypogonadism (IHHH) and Kallmann syndrome (KSN). The diagnosis of a variety of sexual development diseases such as delayed CDP. But although it has been used in clinical practice for nearly 30 years, The selection of diagnostic indexes and the diagnostic cutting value are still not clear, and the diagnostic value is still controversial. This study compared the patients with different sexual development diseases with normal prepuberty and adults. To explore the best diagnostic index, cutting value and diagnostic value of GnRH excitatory test in the diagnosis and differential diagnosis of the disease. Methods: the changes of LH and FSH in 65 cases of CPP(15 were retrospectively analyzed. The changes of GnRH were compared with 6 cases of prepubertal children and 20 normal adult volunteers. By drawing the operating curve of subjects, the suitable diagnostic indexes and cutting values were discussed and the diagnostic value was evaluated. Results: the differential diagnosis group of CPP and the group of uninitiated puberty (including normal prepubertal children with IHH and KS) should consider the peak value of FSH and LH synthetically. The cutting value was predicted probability 0.93, the sensitivity of diagnosis was 93.3g, the specificity was 71.3% (excluding sex factors), LH peak value was suitable for differentiating female CPP group from pubertal uninitiated group (including normal prepubertal children with IHH and KSs). The peak value of LH was 6.77 IU / L, the sensitivity of diagnosis was 92.3 and the specificity was 70.00.The peak value of LH should be used in differential diagnosis of HH group (including IHH and KS) and CDP group. The cutting value was the peak value of LH 9.74 IUL, the diagnostic sensitivity was 77.5 and the specificity was 85.2. The peak value of LH should also be used for the differentiation between male HH group and CDP group. The best cutting value was also the peak value of LH 9.74 IUL. The diagnostic sensitivity was 77.2 and the specificity was 87.0. Conclusion the ratio GnRH excitatory test is useful for the diagnosis and differential diagnosis of various sexual development diseases, and is of high diagnostic value in the diagnosis and differential diagnosis of CPP. It is advisable to analyze the peak value of LH and FSH synthetically in the evaluation of GnRH. In the diagnosis and differential diagnosis of HH and CDP, its diagnostic value is medium, so it is not suitable to rely solely on GnRH test to differentiate HH from CDP clinically.
【学位授予单位】：南开大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.8

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