Zhongguo quanke yixue (Jan 2025)
Diagnostic Value of LH/FSH Ratio in Rapidly Progressing Central Precocious Puberty Girls
Abstract
Background Central precocious puberty (CPP) is a common endocrine disease in children, which shows an increasing trend year by year in recent years. It can be divided into fast-progressing central precocious puberty (RP-CPP) and slow-progressing central precocious puberty (SP-CPP) through pubertal development. RP-CPP has great harm, but it is difficult to distinguish it from SP-CPP in early clinical stage, mainly relying on the progress of adolescent development and bone age during follow-up. At present, there is a lack of effective laboratory indicators to predict RP-CPP. Objective To investigate the relationship between luteinizing hormone (LH) /follicle-stimulating hormone (FSH) ratio and pubertal development. Methods CPP girls aged 4-10 years old (n=380) admitted to the Children's Hospital Affiliated to Zhengzhou University from January 2020 to May 2022 were regression selected and divided into RP-CPP group (n=130) and SP-CPP group (n=250 cases) according to indicators such as puberal development process. Clinical characteristics of the two groups were compared and analyzed. Univariate and multivariate Logistic regression analysis of the influencing factors of RP-CPP was performed, and ROC curve of LH/FSH ratio on the predictive value of RP-CPP was drawn. Results The height, weight, BMI, IGF-1, difference between bone age and actual age, bilateral ovarian volume, LH base value, estradiol level, LH base value /FSH base value, and LH peak /FSH peak value of girls in RP-CPP group were all higher than those in SP-CPP group, with statistical significance (P<0.05). Regression analysis showed that CPP patients progressed to RP-CPP related serological indexes when LH base value and LH peak /FSH peak were detected. LH base /FSH base value and LH peak /FSH peak were positively correlated with height, IGF-1, LH base value, estradiol level, LH peak, ovarian volume and bone age (P<0.05). ROC curve showed that the LH base /FSH base value and LH peak /FSH peak value were more sensitive and specific than other indexes to the predictive value of RP-CPP. When the LH base /FSH base value was 0.63, the Yoden index reached a maximum of 0.258 (sensitivity 43.1%, specificity 82.7%, AUC=0.644). When the LH peak /FSH peak was 1.39, the maximum Jorden index was 0.276 (sensitivity 74.6%, specificity 53.0%, AUC=0.655). The combined prediction model is better than the single index prediction model (AUC=0.668). The basal gonadotropin levels of children without clinical intervention were analyzed after 6 months of follow-up. It was found that the height increase, ΔLH, ΔFSH, bone age increase and ovarian volume increase in RP-CPP group were significantly higher than those in SP-CPP group after 6 months of follow-up, and the difference was statistically significant (P<0.05) . Conclusion LH base /FSH base value and LH peak /FSH peak are early predictors of RP-CPP. When LH/FSH base value ≥0.63 or LH peak/FSH peak ≥1.39, the possibility of RP-CPP should be considered, and the combined predictive value of the two indicators is better than that of a single indicator. It can be used as an auxiliary reference index for clinical application of gonadotropin-releasing hormone analogue therapy.
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