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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (5): 788-793. doi: 10.19723/j.issn.1671-167X.2024.05.006

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Application of urinary luteinizing hormone in the prediction of central precocious puberty in girls

Jinfang YUAN, Xinli WANG*(), Yunpu CUI, Xuemei WANG   

  1. Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-06-24 Online:2024-10-18 Published:2024-10-16
  • Contact: Xinli WANG E-mail:15133253@qq.com

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Abstract:

Objective: To evaluate the level of first morning voided (FMV) urinary luteinizing hormone (LH) in girls with breast development, and to determine the value of FMV urine LH in the evaluation of central precocious puberty (CPP). Methods: From September 2018 to April 2021, among the patients who were admitted to the Department of Pediatrics of Peking University Third Hospital for "precocious puberty" and underwent gonadotropin-releasing hormone (GnRH) stimulation test, a total of 108 girls were enrolled. According to CPP diagnostic criteria, they were divided into CPP group (n=45) and non-CPP group (n=63). The clinical characteristics and hormone levels of the two groups were compared. Receiver operating characteristic (ROC) curve was used to analyze the cut-off value of FMV urinary LH in the diagnosis of CPP in girls. Further analyses were done to evaluate the value of FMV urinary LH in the diagnosis of CPP using correlation analysis between urinary LH level and common clinical cha-racteristics. Results: ROC curve analysis showed that FMV urine LH level was significant for the diagnosis of CPP. The cut-off value of FMV urine LH was 0.69 IU/L (specificity 56.9%, sensitivity 85.0%, area under curve 0.804, P < 0.001). The basic clinical characteristics without GnRH stimulation test were analyzed by binary Logistic regression analysis, indicating that the level of FMV urine LH, uterine volume, ovarian volume and advanced T-bone age had predictive significance for CPP diagnosis in girls (OR values were 2.125, 1.961, 1.564 and 2.672, respectively). The prediction model was established and the area under the ROC curve was 0.904, P < 0.001. The level of FMV urine LH was positively correlated with the levels of serum LH, FSH and estrogen before GnRH stimulation test, the peak value of blood LH after GnRH stimulation test, T bone age and uterine volume, with r values of 0.462, 0.373, 0.242, 0.360, 0.373 and 0.263, respectively, and P values were < 0.001, < 0.001, 0.013, < 0.001, < 0.001 and 0.007, respectively. Conclusion: FMV urine LH can provide a good indication for the diagnosis of CPP. Combining with bone age advanced level and pelvic ultrasound measurement, the predictive value of FMV urine LH can be further improved for the diagnosis of CPP in girls.

Key words: Puberty, precocious, Urine, Luteinizing hormone, Gonadotropin-releasing hormone, Ultrasonography

CLC Number: 

  • R725.85

Table 1

Clinical characteristics of 108 girls with precocious puberty"

Items CPP group (n=45) Non-CPP group (n=63) F/χ2χvalue P value
Age/years 7.8±0.8 7.1±0.9 2.765 0.099
Height/cm 134.4±6.8 127.6±6.9 0.179 0.673
Weight/kg 31.1±5.9 27.2±5.2 0.645 0.424
BMI/(kg/m2) 17.1±2.2 16.6±2.2 0.295 0.588
Bone age/years
  R bone age 9.4±0.9 8.2±1.0 1.550 0.217
  C bone age 9.9±1.5 8.4±1.3 0.059 0.809
  T bone age 9.8±0.9 8.6±1.2 1.715 0.194
  Advanced R bone age 2.0 (1.5, 2.6) 1.7 (0.8, 2.0) 2.952 0.003
  Advanced C bone age 2.2 (1.5, 2.7) 1.4 (0.5, 1.8) 3.428 0.001
  Advanced T bone age 1.5 (1.2, 1.9) 1.3 (0.5, 1.6) 2.783 0.005
  Urine LH/(IU/L) 2.94 (1.04, 8.09) 0.65 (0.38, 1.48) 5.060 ＜0.001
GnRH stimulation test/(IU/L)
  Basal serum LH/(IU/L) 0.67 (0.26, 3.13) 0.21 (0.15, 0.40) 4.368 ＜0.001
  Peak serum LH/(IU/L) 16.10 (8.32, 23.15) 3.50(2.21, 4.66) 8.179 ＜0.001
  Basal serum FSH/(IU/L) 3.22 (1.69, 5.73) 1.89 (1.42, 2.91) 3.218 0.001
  Peak serum FSH/(IU/L) 14.20 (10.35, 20.00) 14.95 (11.48, 19.18) -0.230 0.818
  Basal serum estrogen/(pmol/L) 115.0 (73.4, 162.5) 98.8 (73.4, 124.8) 0.807 0.420
  Peak serum estrogen/(pmol/L) 449.0 (297.5, 743.5) 244.0 (188.0, 381.5) 4.350 ＜0.001
Uterine volume/mL 2.78 (2.00, 3.63) 1.30 (0.98, 2.01) 4.991 ＜0.001
Ovarian volume/mL 3.16 (2.33, 5.13) 2.38 (1.80, 3.51) 2.822 0.005

Figure 1

ROC curve of FMV urine LH leve"

Table 2

Binary Logistic regression analysis of clinical characteristics"

Items P value OR 95%CI
FMV urine LH 0.023 2.125 1.11-4.07
Uterine volume 0.070 1.961 0.95-4.06
Ovarian volume 0.040 1.564 1.02-2.40
Advanced T bone age 0.064 2.672 0.94-7.58

Figure 2

ROC curve of FMV urine LH and prediction probability"

Figure 3

Regression analysis of serum hormone level, bone age, uterine volume and FMV urinary LH"

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