目的 探讨骨龄、黄体生成素(LH)/促卵泡生成素(FSH)比值联合血清25-羟维生素D[25-(OH)D]水平对快进展型中枢性性早熟(RP-CPP)的预测价值。方法 回顾性选取武警江西总队医院及南昌市人民医院于2021-01至2023-07收治的116例中枢性性早熟(CPP)女童作为建模组对象,根据女童的青春期发育进程等指标将其分为RP-CPP组(n=42)与缓慢进展型中枢性性早熟(SP-CPP)组(n=74),按照建模组与验证组7∶3的比例,另选取同上两所医院2023-08至2024-06期间50例CPP女童作为验证组,分为RP-CPP组(n=16)与SP-CPP组(n=34),对构建的预测模型进行外部验证。对建模组女童的数据进行单因素分析,采用二元logistic回归分析,从多个相关因素中筛选出独立影响因素,并构建列线图模型,结合已有的验证组数据对预测模型进行验证。结果 单因素和多因素logistic回归分析表明,骨龄年龄差、LH基础值、LH峰值/FSH峰值、25-(OH)D水平均是女童RP-CPP发生的独立影响因素(均P<0.05)。建立的列线图模型经过验证表明,校准图显示预测模型性能良好;建模组受试者工作特征(ROC)曲线的线下面积(AUC)为0.654;验证组ROC的AUC为0.687,校正曲线拟合度良好(均P<0.05)。结论 骨龄年龄差、LH基础值、LH峰值/FSH峰值、25-(OH)D水平均是女童RP-CPP发生的独立影响因素。
Abstract
Objective To explore the predictive value of bone age, luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio combined with serum 25-hydroxyvitamin D[25-(OH)D] level for rapidly progressive central precocious puberty (RP-CPP). Methods A retrospective study was conducted on 116 girls with central precocious puberty (CPP) admitted to Jiangxi Provincial Corps Hospital of Chinese People’s Armed Police Force and Nanchang People’s Hospital from January 2021 to July 2023. These girls were divided into RP-CPP group (n=42) and the slowly progressive central precocious puberty (SP-CPP) group (n=74) based on their pubertal development process and other indicators. Another 50 girls with CPP were selected from the same hospitals from August 2023 to June 2024 at a ratio of 7∶3 as the validation group, which was further divided into the RP-CPP group (n=16) and the SP-CPP group (n=34). The constructed prediction model was externally validated. The data of the girls in the modeling group were analyzed using univariate analysis, and binary logistic regression analysis was used to select independent influencing factors, and a nomogram model was constructed. The prediction model was validated by combining the existing validation group data. Results Univariate and multivariate logistic regression analyses indicated that bone age difference, LH baseline value, LH peak/FSH peak, and 25-(OH)D level were independent influencing factors for the occurrence of RP-CPP in girls (all P＜0.05). The established nomogram model was validated, and the calibration plot showed good performance of the prediction model. The area under the receiver operating characteristic (ROC) curve for the modeling group was 0.654, and for the validation group, it was 0.687, with good fit of the calibration curve (all P＜0.05). Conclusions Bone age difference, LH baseline value, LH peak/FSH peak, and 25-(OH)D level are independent influencing factors for the occurrence of RP-CPP in girls.
关键词
中枢性性早熟 /
黄体生成素 /
促卵泡生成素 /
骨龄 /
血清25-羟维生素D /
预测价值
Key words
central precocious puberty /
luteinizing hormone /
follicle-stimulating hormone /
bone age /
serum 25-hydroxyvitamin D /
predictive value
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