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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (04) : 360 -365. doi: 10.3877/cma.j.issn.1672-6448.2022.04.014

小儿超声影像学

盆腔超声在女童性早熟评估中的价值
夏斌1, 魏华星1, 潘陈可1, 骆云凯1, 何慧灵1, 许寿星1, 郑哲岚2,†()   
  1. 1. 322000　义乌，浙江大学医学院附属第四医院超声科
    2. 310003 杭州，浙江大学医学院附属第一医院心血管超声中心
  • 收稿日期:2021-09-13 出版日期:2022-04-01
  • 通信作者: 郑哲岚

Value of pelvic ultrasound in evaluating precocious puberty in girls

Bin Xia1, Huaxing Wei1, Chenke Pan1, Yunkai Luo1, Huiling He1, Shouxing Xu1, Zhelan Zheng2,†()   

  1. 1. Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University Medical College, Yiwu 322000, China
    2. Echocardiography and Vascular Ultrasound Center, Zhejiang University School of Medicine, The First Affiliated Hospital, Hangzhou 310003, China
  • Received:2021-09-13 Published:2022-04-01
  • Corresponding author: Zhelan Zheng
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引用本文：

夏斌, 魏华星, 潘陈可, 骆云凯, 何慧灵, 许寿星, 郑哲岚. 盆腔超声在女童性早熟评估中的价值[J]. 中华医学超声杂志（电子版）, 2022, 19(04): 360-365.

Bin Xia, Huaxing Wei, Chenke Pan, Yunkai Luo, Huiling He, Shouxing Xu, Zhelan Zheng. Value of pelvic ultrasound in evaluating precocious puberty in girls[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(04): 360-365.

目的

探讨盆腔超声在女童性早熟及其不同类型评估中的价值。

方法

选取2019年8月至2021年8月在浙江大学医学院附属第四医院生长发育门诊临床诊断为中枢性性早熟（CPP）和外周性性早熟（PPP）的女童各30例，并选取同期30例正常女童作为对照组。所有纳入对象均行盆腔超声检查，比较3组女童的年龄、体质量指数、宫体厚度、宫体长径/宫颈长径、子宫体积、卵巢体积、最大卵泡长径的差异，并绘制3组比较有差异的超声参数鉴别CPP、PPP及正常者的ROC曲线，评估各项参数的效能。

结果

CPP组宫体厚度、子宫体积、卵巢体积、最大卵泡长径均大于对照组和PPP组（P均＜0.05）。PPP组宫体厚度、子宫体积、卵巢体积、最大卵泡长径均大于对照组（P均＜0.05）。以促性腺激素释放激素（GnRH）激发试验结果为金标准，宫体厚度、子宫体积、卵巢体积、最大卵泡长径鉴别CPP与PPP的ROC曲线下面积为0.900、0.849、0.843、0.755；鉴别CPP与正常女童的ROC曲线下面积为0.941、0.887、0.926、0.769；鉴别PPP与正常女童的ROC曲线下面积为0.814、0.811、0.706、0.813。其中宫体厚度的ROC曲线下面积最大，以宫体厚度＞1.39 cm为截断值，其鉴别女童CPP与PPP的敏感度86.7%，特异度90.0%；以宫体厚度＞1.07 cm为截断值，其鉴别CPP与正常女童的敏感度96.7%，特异度90.0%；以宫体厚度＞0.96 cm为截断值，其鉴别PPP与正常女童的敏感度80.0%，特异度86.7%。

结论

盆腔超声多项参数对女童性早熟评估及不同类型的鉴别有较好的临床应用价值，宫体厚度作为一项新的评估参数值得进一步关注，可将这些参数作为性早熟的初筛方法，为临床明确诊断提供可靠依据。

关键词: 性早熟, 超声检查, 子宫, 卵巢
Objective

To explore the value of pelvic ultrasound in evaluating precocious puberty in girls and different types of precocious puberty.

Methods

Thirty girls with central precocious puberty (CPP) and 30 girls with peripheral precocious puberty (PPP) diagnosed clinically from August 2019 to August 2021 were selected, and 30 girls with no significant abnormalities in pelvic ultrasound, gonadotropin releasing hormone (GnRH) stimulation test, and bone age measurement were selected as a normal control group. All the children underwent pelvic ultrasound examination. The differences in age, body mass index, uterine thickness, uterine length diameter/cervical length diameter, uterine volume, ovarian volume, and maximum follicular length diameter were compared among the three groups of girls, and the ROC curves of different ultrasound parameters for CPP, PPP, and normal subjects were drawn to evaluate the evaluation efficiency of each parameter.

Results

The uterine thickness, uterine volume, ovarian volume, and maximum follicular length diameter in the CPP group were significantly higher than those in the control group and PPP group (P＜0.05). The uterine thickness, uterine volume, ovarian volume, and maximum follicular length diameter in the PPP group were significantly higher than those in the control group (P＜0.05). Taking the GnRH stimulation test as the gold standard, the areas under the ROC curves of uterine thickness, uterine volume, ovarian volume, and maximum follicle length diameter to distinguish CPP and PPP were 0.900, 0.849, 0.843, and 0.755; the areas under the ROC curves to distinguish CPP from normal girls were 0.941, 0.887, 0.926, and 0.769; and the areas under the ROC curves to distinguish PPP from normal girls were 0.814, 0.811, 0.706, and 0.813, respectively. The area under the ROC curve of uterine thickness was the largest, and the cut-off value of uterine thickness＞1.39 cm yielded an 86.7% sensitivity and 90.0% specificity in identifying girls with CPP and PPP. Taking the uterine thickness＞1.07 cm as the cut-off value, the sensitivity and specificity for distinguishing CPP from normal girls were 96.7% and 90.0%, respectively. Taking the uterine thickness＞0.96 cm as the cut-off value, the sensitivity and specificity for distinguishing PPP from normal girls were 80.0% and 86.7%.

Conclusion

Multiple parameters of pelvic ultrasound have good clinical application value in the evaluation of girls' precocious puberty and the identification of different types. As a new evaluation parameter, uterine body thickness deserves further attention. These parameters can be used as the primary screening method for precocious puberty to provide a reliable basis for clinical diagnosis.

Key words: Precocious puberty, Ultrasonography, Uterus, Ovary
表1 CPP组、PPP组与正常对照组年龄、BMI比较（
xˉ
±s）
组别 例数 年龄（岁） BMI（kg/m2）
CPP组 30 7.17±1.09 18.27±0.78
PPP组 30 7.13±0.97 18.38±0.80
正常对照组 30 7.00±0.95 18.37±0.63
F值 0.232 0.237
P值 0.794 0.789
表2 CPP组、PPP组与正常对照组盆腔超声参数比较（
xˉ
±s）
组别 例数 宫体厚度（cm） 宫体长径/宫颈长径 子宫体积（cm3） 卵巢体积（cm3） 最大卵泡长径（cm）
CPP组 30 1.68±0.37ab 1.45±0.32 5.11±1.95ab 4.57±1.59ab 0.58±0.13ab
PPP组 30 1.11±0.24a 1.33±0.20 2.91±1.08a 2.66±1.20a 0.49±0.10a
正常对照组 30 0.90±0.46 1.23±0.45 1.85±2.03 1.86±1.18 0.41±0.16
F值 36.556 3.100 27.436 32.877 12.562
P值 0.000 0.050 0.000 0.000 0.000
图1 中枢性性早熟女童盆腔超声参数图像。图a为子宫体纵切面图像；图b为子宫颈纵切面图像；图c为测量卵泡长径图像；图d为测量卵巢径线图像
图2 外周性性早熟女童盆腔超声参数图像。图a为子宫颈纵切面图像；图b为子宫体纵切面图像；图c为测量卵巢径线图像，图d为测量卵泡长径图像
图3 盆腔超声参数鉴别中枢性性早熟组与正常对照组的ROC 曲线
表3 超声参数鉴别CPP与正常女童的ROC曲线结果
超声参数 约登指数 敏感度（%） 特异度（%） AUC 最佳截断值
宫体厚度 1.07 96.7 90.0 0.941 1.07 cm
子宫体积 1.90 100.0 83.3 0.887 2.76 ml
卵巢体积 2.99 86.7 86.7 0.926 2.61 ml
最大卵泡长径 0.47 86.7 86.7 0.769 0.51 cm
图4 盆腔超声参数鉴别外周性性早熟组与正常对照组的ROC曲线
表4 超声参数鉴别PPP与正常女童的ROC曲线结果
超声参数 约登指数 敏感度（%） 特异度（%） AUC 最佳截断值
宫体厚度 0.965 80.0 86.7 0.814 0.96 cm
子宫体积 1.64 86.7 80.0 0.811 1.95 ml
卵巢体积 1.59 90.0 50.0 0.706 1.56 ml
最大卵泡长径 0.44 76.7 83.3 0.813 0.46 cm
图5 盆腔超声参数鉴别CPP组与PPP组的ROC曲线
表5 超声参数鉴别CPP与PPP的ROC曲线结果
超声参数 约登指数 敏感度（%） 特异度（%） AUC 最佳截断值
宫体厚度 1.39 86.7 90.0 0.900 1.39 cm
子宫体积 3.59 80.0 76.7 0.849 3.59 ml
卵巢体积 3.50 76.7 76.7 0.843 3.50 ml
最大卵泡长径 0.50 86.7 70.0 0.755 0.53 cm
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