發(fā)布時(shí)間：2018-03-02 01:20

  本文關(guān)鍵詞： GnRH CPP IHH Kallmann綜合征 CDP　出處：《南開大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景與目的：促性腺激素釋放激素(GnRH)興奮試驗(yàn)是通過GnRH類似物(戈那瑞林等)興奮垂體分泌黃體生成素(LH)和卵泡刺激素(FSH)來評(píng)價(jià)垂體促性腺激素細(xì)胞的儲(chǔ)備功能以及下丘腦-垂體-性腺(HPG)軸興奮狀態(tài)的一種常用試驗(yàn)方法。目前廣泛應(yīng)用于中樞性性早熟(CPP)、特發(fā)性低促性腺激素性性腺功能減退(IHH)、Kallmann綜合征(KS)、體質(zhì)性青春期延遲(CDP)等多種性發(fā)育疾病的診斷。但雖然在臨床上的應(yīng)用已近30年,其診斷指標(biāo)的選擇及診斷切割值仍不十分明確,診斷價(jià)值亦存在一定爭議。本研究通過對(duì)不同性發(fā)育疾病患者與正常青春期前期及成年人的比較,探討了GnRH興奮試驗(yàn)在CPP、IHH、KS、CDP疾病診斷及鑒別中的最佳診斷指標(biāo)及切割值和診斷價(jià)值。方法：對(duì)確診為CPP(15例),IHH(65例)、KS(31例)、CDP(27例)患者行GnRH興奮試驗(yàn)時(shí)LH和FSH的變化進(jìn)行回顧性分析,并與青春期前期兒童(6例)及正常成年志愿者(20例)行GnRH興奮試驗(yàn)時(shí)LH、FSH的變化進(jìn)行比較,通過繪制受試者工作曲線(ROC)探討了適宜的診斷指標(biāo)及切割值并評(píng)價(jià)了診斷價(jià)值的高低。 結(jié)果：1、鑒別診斷CPP組與青春期未啟動(dòng)者組(包括正常青春期前期兒童、IHH及KS)宜綜合考慮FSH峰值和LH峰值,切割值為預(yù)測概率0.93,診斷的敏感度為93.3%,特異性為71.3%(排除性別因素)；2、對(duì)于女性CPP組與青春期未啟動(dòng)組(包括正常青春期前期兒童、IHH及KS)的鑒別宜采用LH峰值,切割值為LH峰值6.77IU/L,診斷敏感度為92.3%,特異性為70.0%；3、鑒別診斷HH組(包括IHH與KS)與CDP組宜采用LH峰值,切割值為LH峰值9.74IU/L,診斷敏感度為77.5%,特異性為85.2%(排除性別因素)；4、對(duì)于男性HH組與CDP組的鑒別也宜采用LH峰值,最佳切割值也為LH峰值9.74IU/L,診斷敏感性為77.2%,特異性為87.0%。 結(jié)論：GnRH興奮試驗(yàn)對(duì)于多種性發(fā)育疾病的診斷與鑒別均具有一定的作用,在CPP的診斷與鑒別中診斷價(jià)值高,其評(píng)價(jià)宜綜合分析LH峰值及FSH峰值；在HH與CDP的診斷與鑒別中其診斷價(jià)值則為中等,臨床上不宜單純依賴GnRH試驗(yàn)來鑒別HH與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.
【學(xué)位授予單位】：南開大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.8

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