To Explore The Diagnostic Value Of Serum LH,LH/FSH And INHB In Girls With Activation Of HPG Axis

Objective:To explore the diagnostic value of serum LH,LH/FSH and INHB in girls with activation of HPG axis.Methods:From January 2017 to December 2021,a total of 237 girls with breast development and a bone age(BA)ratio of less than 1 year were enrolled in our hospital.All girls underwent gonadotropin-releasing hormone(Gn RH)stimulation test.According to the Gn RH stimulation test,156 cases were divided into the Gn RH stimulation positive group and 81 cases into the Gn RH stimulation negative group.The girls were further divided into <8 years old and ≥8 years old according to the age of precocious puberty(PP),with the <8 years old girls divided into 80 cases in the central precocious puberty(CPP)group and 59 cases in the non-CPP group;the ≥8 years old girls were divided into 76 cases in the rapid progressive puberty(RPP)group and 22 cases in the non-RPP group.The basic data,including basic luteinizing hormone(B-LH)and follicle-stimulating hormone(B-FSH),inhibin B(INHB),peak luteinizing hormone(P-LH)and peak follicle-stimulating hormone(P-FSH),BA,uterine and ovarian pelvic ultrasound,and other parameters,were collected and compared among them.A ROC curve was used to analyze the diagnostic value of serum LH,LH/FSH,and INHB for the HPG axis in girls.Results:A statistically significant difference(P<0.05)was found between the Gn RH-positive group and the Gn RH-negative group in terms of CA,age at onset,height,breast Tanner stage,BA,serum IGF-1,INH-B,E2,B-LH,B-FSH,B-LH/FSH,P-LH,uterine volume,uterine body length,cervical length,uterine length,and left and right ovarian volumes.B-LH,INHB,and BA were screened as independent predictors.When the Youden index showed the maximum value,the AUCs of B-LH,INHB,and BA were 0.830,0.683,and0.757,respectively.The optimal threshold for B-LH was 0.31 IU/L,with a sensitivity of80% and specificity of 71%;B-LH was taken at 0.805 IU/L,with a sensitivity of The optimal threshold for INHB was 15.25 pg/ml,with a sensitivity of 70.8% and specificity of 62.9%.The optimal threshold for BA was 9.95 years,with a sensitivity of 81.5% and a specificity of 61.3%.In girls <8 years of age,the CPP group had greater CA,age at onset,BA,and BA-CA,a longer duration of disease,higher height,and significantly higher serum IGF-1,INH-B,E2,B-LH,B-FSH,B-LH/FSH,P-LH,and P-LH/FSH than the non-CPP group,and the CPP group had higher uterine volume,uterine body length,cervical length,uterine length,and left and right ovarian volumes in the CPP group than in the non-CPP group,and the difference between the two groups was statistically significant(p<0.05).The AUCs of B-LH and BA were 0.776 and 0.692,respectively,when the Youden index showed a maximum value.The optimal threshold for B-LH was 0.25 IU/L(95% CI: 0.700–0.852),with a sensitivity of 85% and specificity of 59.3%.The optimal threshold for BA was 9.75 years(95% CI: 0.603–0.780),with a sensitivity of 61.3% and a specificity of 74.6%.In girls ≥8 years of age,BA,INH-B,B-LH,B-FSH,B-LH/FSH,P-LH,and P-LH/FSH were significantly higher in the RPP group than in the non-RPP group,and uterine volume,uterine body length,uterine length,and left and right ovarian volumes were also greater than in the non-rapidly progressive puberty group,with statistically significant differences between the two groups(p 0.05).B-LH/FSH was screened as an independent predictor,and the AUC for B-LH/FSH when the Youden index showed a maximum was 0.917,respectively,and the optimal threshold for B-LH/FSH was 0.07(95% CI: 0.854–0.981),with a sensitivity of 96.1% and specificity of72.7%.Conclusions:B-LH,B-LH/FSH,and INHB can all be used as predictors of HPG axis initiation in girls.The optimal threshold for B-LH to predict a positive Gn RH stimulation test is 0.31IU/L,with a sensitivity of 80% and specificity of 71%;B-LH is 0.805 IU/L,with a sensitivity of 37.7% and specificity of 100%.For girls <8 years,the optimal threshold for B-LH was chosen to be more sensitive at 0.25 IU/L,but for girls ≥8 years,the reference for B-LH/FSH was more significant.