盆腔超声在ICPP诊断及短期疗效评估中的应用

Application of pelvic ultrasound in ICPP diagnosis and short-term efficacy evaluation

摘要

目的 探讨盆腔超声对于特发性中枢性性早熟(ICPP)的诊断及促性腺激素释放激素类似物(GnRHa)治疗后短期疗效的评估价值。方法 选取2019年12月至2022年11月于陕西省人民医院诊断为ICPP的女童72例为研究组,其中接受GnRHa治疗的ICPP女童43例为观察组,选取同期于我院健康体检女童64例为对照组,所有女童均接受盆腔超声检查.比较研究组和对照组盆腔超声参数的差异,比较观察组治疗前后激素水平和盆腔超声参数的变化;探讨ICPP组盆腔超声参数与促性腺激素释放激素(GnRH)激发实验结果之间相关性,采用受试者工作特征(ROC)曲线分析盆腔超声单一参数及多参数联合对于ICPP的诊断价值。结果 研究组子宫长径、子宫横径、子宫前后径、子宫体体积、宫体/宫颈、双侧卵巢容积、双侧卵泡数目、双侧卵泡直径＞0.4cm个数及双侧最大卵泡直径参数均显著大于对照组,差异具有统计学意义(z值介于-7.971~-3.327之间,P＜0.05);观察组治疗后身高、体重、盆腔超声各参数及GnRH激发实验结果较治疗前均明显降低,差异具有统计学意义(t/z值介于-9.491~-0.881之间,P＜0.05),BMI差异无统计学意义(t值为-1.844,P＞0.05).相关性分析显示子宫长径、子宫横径、子宫前后径、子宫体体积、双侧卵巢容积及右侧最大卵泡直径与GnRH激发实验结果呈显著正相关(P＜0.05).单一参数诊断ICPP的曲线下面积(AUC)为0.607~0.897,多参数联合诊断的AUC为0.956,诊断价值更高。结论 ICPP会影响女童生长发育状况,GnRHa治疗可有效改善该情况.盆腔超声多参数联合对于ICPP有较高的诊断价值,可为临床ICPP的诊断及短期疗效评估提供重要的依据.

Abstract

Objective To investigate the value of pelvic ultrasound for the diagnosis of idiopathic central precocious puberty (ICPP) and the assessment of short-term efficacy after gonadotropin-releasing hormone analogue (GnRHa) treatment. Methods A total of 72 girls diagnosed with ICPP in Shaanxi Provincial People's Hospital from December 2019 to November 2022 were selected as the study group, of which 43 girls with ICPP who received GnRHa treatment were the observation group, and 64 girls who underwent health checkups in our hospital during the same period were selected as the control group, and all the girls were subjected to pelvic ultrasound examination. The differences in pelvic ultrasound parameters between the study group and the control group were compared, and the changes in hormone levels and pelvic ultrasound parameters in the observation group before and after treatment were compared; the correlation between the pelvic ultrasound parameters of the ICPP group and the results of the gonadotropin-releasing hormone (GnRH) stimulation test were investigated, and the diagnostic value of the pelvic ultrasound parameters of the single-parameter and the combination of the parameters were analysed by using the receiver operating characteristic (ROC) curves for the diagnosis of ICPP. Results The parameters of uterine long diameter, uterine transverse diameter, uterine anterior and posterior diameter, uterine body volume, uterine body/cervix, bilateral ovarian volume, bilateral follicle number, bilateral follicle diameter ＞0.4cm and bilateral maximum follicle diameter were all significantly larger than those of the control group, and the differences were statistically significant (z＝-7.971--3.327, respectively, all P＜0.05). The height, weight, pelvic ultrasound parameters and GnRH stimulation test results were all significantly lower in the observation group than those before treatment, and the difference was statistically significant (t/z＝-9.491--0.881, respectively, P＜0.05), and the difference in BMI was not statistically significant (t＝-1.844, P＞0.05). Correlation analysis showed that uterine long diameter, transverse uterine diameter, anterior-posterior uterine diameter, uterine corpus volume, bilateral ovarian volume and right maximal follicle diameter were significantly and positively correlated with the results of GnRH stimulation experiments (all P＜0.05). The area under the curve (AUC) for single-parameter diagnosis of ICPP was 0.607-0.897, and the AUC for multi-parameter combined diagnosis was 0.956, which had a higher diagnostic value. Conclusion ICPP affects the growth and development of girls, and GnRHa treatment can effectively improve the situation. Multi-parameter pelvic ultrasound has a higher diagnostic value for ICPP, which can provide an important basis for the diagnosis of ICPP and the evaluation of short-term efficacy.

关键词

盆腔超声 / 特发性中枢性性早熟 / 诊断 / 疗效监测

Key words

pelvic ultrasound / idiopathic central precocious puberty / diagnosis / therapeutic efficacy monitoring

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