Discussion On The Optimization Of The Screening Of Idiopathic Central Precocious Puberty Girls

Objective: The retrospective study of the 68 cases of girls aged 4.5-9 years old with precocious puberty from Pediatric Department of Tianjin Medical University General Hospital was performed.This study established simplified gonadotropin releasing hormone(Gn RH)stimulation test models and compared the diagnostic effects of different simplified Gn RH stimulation test model on ICPP girls.This study compared the screening effects of serum basal luteinizing hormone and estradiol on ICPP girls and compared the screening effects of bone age index(BAI)and bone age-actual age on ICPP girls and compared the screening effects of measurements of uterus and ovaries on ICPP girls in order to determine which criteria can provide a rapid and accurate screen of ICPP for reducing pain in children.Method: The clinical data of 68 girls aged 4.5-9 years with precocious puberty was collected and retrospectively analyzed from Pediatric Department of Tianjin Medical University General Hospital from January 2016 to September 2017.According to the Gn RH stimulation test,the girls were divided into ICPP and PT group.Analyzed the clinical manifestation、physical examination 、laboratory result、bone X ray and pelvic ultrasound results between different group.Results: According to the statistical analysis of the clinical data of girls aged 4.5-9 years old with precocious puberty who were diagnosed in the Pediatric Endocrine Clinic from January 2016 to September 2017,we summarized:1.The actual age,the time of breast development,weight and BMI were not significantly different between ICPP girls and PT girls(P>0.05).;the height and height SDS were significantly higher in ICPP group than PT group(P<0.05).The incidences of overweight and obesity among 68 girls with precocious puberty were 11.76% and 14.71%,respectively.2.The specificity and positive predictive value of the 30 min simplified Gn RH stimulation test and the 30-60 min simplified Gn RH stimulation test were100%.The sensitivity、negative predictive value and accuracy of the 30 min simplified Gn RH stimulation test were 83.7%、 78.1% and 89.6%,respectively;the sensitivity、negative predictive value and accuracy of the 30-60 min simplified Gn RH stimulation test were 86%、 80.0% and 91.18%,respectively.3.The cut-off value of serum basal LH was 0.2 IU/L with the sensitivity 0.679 and the specificity 0.778 for screening ICPP girls and the area under the receiver operating characteristic curve was 0.778.4.When the cut-off value of BA-CA was 1.6,Youden index maximum was 0.442 and the area under the receiver operating characteristic curve was 0.75 with the sensitivity 0.628 and the specificity 0.75 for screening ICPP girls.When the cut-off value of bone age index was 1.18,Youden index maximum was 0.428 and the area under the receiver operating characteristic curve was 0.714 with the sensitivity 0.628 and the specificity 0.80 for screening ICPP girls.5.Under the premise that Tanner stages of girls’ breasts were B2,when the cut-off value of uterine length was 23.5mm,Youden index maximum was 0.503 and the area under the receiver operating characteristic curve was 0.752 with the sensitivity 0.903 and the specificity 0.60 for screening ICPP girls;when the cut-off value of uterine transverse diameter was 12.5mm,Youden index maximum was 0.476 and the area under the receiver operating characteristic curve was 0.757 with the sensitivity 0.756 and the specificity 0.73 for screening ICPP girls;when the cut-off value of uterine volume was 1.34 ml,Youden index maximum was 0.492 and the area under the receiver operating characteristic curve was 0.770 with the sensitivity 0.752 and the specificity 0.76 for screening ICPP girls;when the cut-off value of the number of the follicles over 4mm in ovaries was 2.75,Youden index maximum was 0.450 and the area under the receiver operating characteristic curve was 0.791 with the sensitivity 0.80 and the specificity 0.65 for screening ICPP girls.Conclusion: 1.The 30-60 min simplified Gn RH stimulation test was adequate for diagnosis of ICPP girls and should be considered as a replacement for classical Gn RH stimulation test for rapid diagnosis and reducing pain of children.The diagnostic effect of the 30-60 min simplified Gn RH stimulation test for ICPP girls was better than that of the 30 min simplified Gn RH stimulation test.2.The screening effect of serum basal LH was better than that of E2 for ICPP girls.The cut-off value of serum basal LH was 0.2 IU/L with sensitivity 0.679 and specificity 0.778.3.The screening effect of BA-CA was better than that of bone age index for ICPP girls.The cut-off value of BA-CA was 1.6 with sensitivity 0.628 and specificity 0.75.4.Under the premise that Tanner stages of girls’ breasts were B2,the screening effect of the number of follicles over 4mm in ovaries was better than that of the volum 、length and transverse diameter of uterus for ICPP girls.The cut-off value of the number of the follicles over 4mm in ovaries was 2.75 with sensitivity 0.80 and specificity 0.65 for ICPP girls.