COVID-19 大流行期间女童性早熟的鉴别诊断：一项初步研究。
Differential diagnosis of precocious puberty in girls during the COVID-19 pandemic: a pilot study.
机构信息
Pediatrics Department, Beijing Jishuitan Hospital, Beijing, China.
Acupuncture Department, Beijing Jishuitan Hospital, Beijing, China.
出版信息
BMC Pediatr. 2023 Apr 20;23(1):185. doi: 10.1186/s12887-023-04009-x.
BACKGROUND
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.
METHODS
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.
RESULTS
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%.
CONCLUSION
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.
背景
在 COVID-19 大流行期间，探讨 6 至 8 岁特发性早初潮（IPT）和中枢性性早熟（CPP）女孩的鉴别诊断。我们探讨了预测成人身高（PAH）差异，以指导适当的诊断和治疗。
方法
2020 年 1 月至 2021 年 12 月，招募了 6 至 8 岁出现性早熟的中国女孩。她们被分为 IPT 和 CPP 组。记录了临床特征，包括身高、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、卵泡数量（d > 4 毫米）和骨龄（BA）。我们分析了两组的鉴别诊断和 PAH 差异。采用二项逻辑回归分析 CPP 的危险因素，并绘制受试者工作特征（ROC）曲线评估相关指标的诊断价值。
结果
共招募 60 名患者，其中 40 名女孩为 IPT，20 名女孩为 CPP。整个队列中超重和肥胖的患病率为 25%（15/60），IPT 组明显高于 CPP 组，分别为 32.5%（13/40）和 10%（2/20）（P=0.045）。LH、子宫体积、卵泡数量和 BA 存在显著差异（P<0.05）。IPT 和 CPP 的受损 PAH 分别为 0.01 ± 1.19 SD 和 0.62 ± 0.94 SD，差异有统计学意义（P=0.047）。逻辑回归分析显示，LH 和卵泡数量是 CPP 的独立危险因素。ROC 曲线显示，LH 和卵泡数量的曲线下面积（AUC）分别为 0.823 和 0.697。LH 截断值为 0.285 IU/L 时的灵敏度和特异度分别为 78.9%和 77.8%。卵泡数截断值为 3.5 时的灵敏度和特异度分别为 89.5%和 52.8%。
结论
6 至 8 岁性早熟女孩超重和肥胖的患病率较高。不能将体格发育数据用于 IPT 和 CPP 的鉴别诊断。基础 LH 高于 0.285 IU/L 和卵泡数大于 4 是提示 CPP 的重要特征。CPP 患者的 PAH 受损，但 IPT 患者的 PAH 不受损。
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