Value Of Serum AMH And INHB In The Diagnosis And Treatment Of Central Precocious Puberty And Early And Fast Puberty Girls

Objective:To investigate the role of serum anti-mullerian hormone(AMH)and inhibin-B(INHB)in central precocious puberty precocious puberty,CPP)and rapidly-progressive puberty(early and fast puberty,EFP).Methods:From January 2021 to December 2022,90 girls with central precocious puberty,fast progressive early development and premature thelarche(PT)and 45 undeveloped healthy girls were enrolled in the Department of Endocrinology,Genetics and Metabolism of Jiangxi Children’s Hospital.Clinical data of age,height,weight,sexual development,sex hormones,AMH,INHB levels and gonad ultrasound were collected.The data of CPP group and non-CPP group(PT group and healthy group)were compared,and the diagnostic value of AMH and INHB in predicting CPP girls was determined by receiver operating characteristic curve(ROC)method.The data of EFP group,CPP group and health group were compared using ROC method to determine whether AMH and INHB could be used for early warning of EFP girls,and Spearman correlation analysis was used to analyze the correlation of each index.Girls diagnosed with CPP or EFP were subsequently treated with gonadotropin-releasing hormone analogue(Gn RHa),AMH,INHB,basal FSH,basal LH,E2,FSH peak value,LH peak value,uterine volume(UV),mean ovarian volume(M-OV)and sexual development assessment were performed at 6 and 12 months of treatment.The changes of each index before and after treatment were compared to explore whether AMH and INHB can be used to evaluate the therapeutic effect of Gn RHa.Results:There was no significant difference in AMH levels between the CPP group and the non CPP group,but the CPP group had higher levels than the PT group,while the CPP group had higher levels of INHB than the non CPP group.The area under the ROC curve for INHB diagnosis of CPP was 0.791(p<0.001),with sensitivity and specificity of 81.5% and 61.1%,respectively,while the area under the ROC curve for AMH diagnosis of CPP was<0.5(p=0.791).AMH is negatively correlated with levels of basal LH,basal FSH,LH peak,and FSH peak.The area under the ROC curve for early warning EFP by INHB was 0.807(p<0.001),with sensitivity and specificity of88.7% and 60.6%,respectively;The area under the ROC curve of UV early warning EFP was 0.794(p<0.001),with sensitivity and specificity of 75.5% and 79.0%,respectively;The area under the ROC curve of INHB combined with UV early warning EFP was 0.813(p<0.001),with corresponding sensitivity and specificity of96.2% and 57.6%,respectively.In EFP,INHB is positively correlated with UV,basal LH,basal FSH,and basal LH/basal FSH.After 6 months of Gn RHa treatment,INHB levels showed a significant decrease in both CPP and EFP patients.After 12 months of treatment,the INHB level also showed a significant decrease in CPP and EFP,and the decrease in INHB after treatment was positively correlated with the decrease in LH peak and FSH peak,but not with the decrease in basal LH,basal FSH,E2,UV,and M-OV.The changes in AMH levels before and after treatment were not statistically significant.Conclusions:1.this study confirms the diagnostic value of INHB for CPP girls;2.this study indicates that AMH levels can be used as a potential indicator to distinguish between CPP and PT;3.the combination of INHB level and UV detection is significant for early warning EFP girls in clinical practice;4.INHB has important reference value in evaluating the efficacy of Gn RHa in girls with CPP and EFP.