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目的研究ROC曲线分析在特发性性早熟(idiopathic precocious puberty,IPP)女孩骨龄诊断中的实用价值。方法参照“金标准”选择特发性性早熟患儿55例,年龄为3．2岁-9．9岁(7．55±1．90) 岁。对照组包括:A组。10岁以后月经初潮者为14例,平均年龄为(11．45±1．05)岁;B组。8岁-10岁,体重偏轻者25例,平均年龄为(9．2±0．67)岁;C组。8岁-10岁,体重正常者32例,平均年龄为(9．11± 0．74)岁;D组。8岁-10岁,体重偏重者12例,平均年龄为(9．61±0．66)岁。回顾性分析初诊时,第一张左手腕X光片,用TW2法盲法分期,骨龄结果分为13骨骨龄、7骨骨龄和20骨骨龄3个系统,每个系统设5 个工作点,即(1)>P97、(2)>P90、(3)>P75、(4)>P50和(5)≤P50。结果敏感度和特异度都比较高的有以下4个工作点:(1)13骨骨龄的“>P90”点(Sen=0．836,Spe=0．916);(2)7骨骨龄的“>P90”点 (Sen=0．746,Spe=0．916);(3)20骨骨龄的“>P90”点(Sen=0．746,Spe=0．964);(4)“>P75”点(Sen= 0．982,Spe=0．783)。3条ROC曲线下面积分别为:(1)13骨骨龄A13为0．939±0．019(95％CI为0．902- 0．977);(2)7骨骨龄A7为0．899±0．028(95％CI为0．845-0．954);(3)20骨骨龄A20为0．958±0．014 (95％Cl为0．930-0．986)。结论 13骨骨龄和20骨骨龄诊断性早熟有高度准确性;“13骨骨龄>P90”工作点为综合考虑了敏感度和特异度之后最佳的一点,故确定为诊断性早熟的正常值临界点。
Objective To study the value of ROC curve analysis in the diagnosis of idiopathic precocious puberty (IPP). Methods According to the “gold standard”, 55 children with idiopathic precocious puberty were selected, aged from 3.2 to 9.9 years old (7.55 ± 1.90) years old. Control group includes: Group A. After the age of 10 menstruation was 14 cases, the average age was (11.45 ± 1.05) years old; B group. The average age was (9.2 ± 0.67) years old, ranging from 8 years old to 10 years old. 32-year-old to 10-year-old, 32 normal weight, the average age was (9.11 ± 0.74) years old; 8-year-old -10 years old, 12 cases of overweight, the average age was (9.61 ± 0.66) years old. Retrospective analysis of first visit, the first left wrist X-ray film, using the TW2 method of blind staging, bone age results are divided into 13 bone age, bone age of 7 and 20 bone age 3 systems, each system has 5 working points, namely (1)> P97, (2)> P90, (3)> P75, (4)> P50 and (5) P90” point for 20 skeletal age (Sen = P75 “point (Sen = 0.982, Spe = 0.783). The area under the three ROC curves were: (1) 13 bone age A13 0.939 ± 0.019 (95% CI 0.902-0.977); (2) 7 bone age A7 was 0.899 ± 0.028 (95% CI 0.845-0.954); (3) 20 bone age A20 was 0.958 ± 0.014 (95% Cl 0.930-0.986). Conclusion 13 bone age and 20 bone age diagnosis of precocious puberty with a high degree of accuracy; ”13 bone age> P90" work point is the best point after considering the sensitivity and specificity, it is determined as the critical value of the diagnosis of precocious puberty point.