Clinical characteristics in RP-CPP and SP-CPP
61 children were diagnosed with CPP, including 30 girls diagnosed with RP-CPP ( mean age 7.37 ± 0.35 years ) and 31 girls diagnosed with SP-CPP ( mean age 7.30 ± 0.34 years ). The general characteristics of both groups are shown in Table 1. The BAI of the RP-CPP group was significantly higher than that of the SP-CPP group (P = 0.000 ). In terms of sex hormone indicators, the levels of BLH, BLH/BFSH and PLH/PFSH were also significantly different between the two groups (P < 0.05). The ovarian volume of the RP-CPP group was significantly larger than that of the SP-CPP group ( P = 0.015 ).
Table 1
Clinical characteristics of RP-CPP and SP-CPP girls
| RP-CPP | SP-CPP | p-value |
n | 30 | 31 | |
CA, years | 7.37 ± 0.35 | 7.30 ± 0.34 | 0.393 |
Height, cm | 130.39 ± 4.05 | 128.97 ± 4.50 | 0.198 |
Height-SDS | 1.15 ± 0.57 | 0.96 ± 0.59 | 0.225 |
Weight, kg | 32.68 ± 4.3 | 31.78 ± 5.2 | 0.463 |
BMI, kg/m2 | 16.56 ± 0.60 | 16.80 ± 0.80 | 0.191 |
BMI-SDS | 0.37 ± 0.28 | 0.46 ± 0.24 | 0.208 |
BAI | 1.17 ± 0.07 | 1.12 ± 0.04 | 0.000a |
E2, pg/mL | 51.19 (32.62,63.65) | 40.18 (33.56,50.65) | 0.282 |
Basal LH, IU/L | 0.77 (0.62,1.16) | 0.32 (0.17,0.49) | 0.000a |
Basal FSH, IU/L | 3.6 (2.39,4.85) | 2.87 (2.1,4.15) | 0.105 |
LH/FSH, Basal | 0.24 ± 0.06 | 0.11 ± 0.03 | 0.000a |
Peak LH, IU/L | 16.08 ± 6.63 | 14.03 ± 5.3 | 0.184 |
Peak FSH, IU/L | 11.06 ± 3.1 | 11.96 ± 2.22 | 0.199 |
LH/FSH, Peak | 1.19 (1.02,1.6) | 1.17 (0.82,1.37) | 0.011a |
Ovarian volume, mL | 2.52 ± 0.8 | 2.04 ± 0.71 | 0.015a |
a indicates statistical significance(p༜0.05), RP-CPP, rapidly progressive central precocious puberty;SP-CPP, slowly progressive central precocious puberty༛n, number; CA, chronological age; BA, bone age; BMI, body mass index; SDS, standard deviation score; BAI, bone age index; E2, estradiol; LH, luteinizing hormone; FSH, follicle stimulating hormone.
Comparison Of Igf-1, Fgf23 And Klotho Levels Among All Subjects
There were significant differences in serum IGF-1, Klotho and FGF23 levels among the RP-CPP group, SP-CPP group and control group (P = 0.000). Girls in the RP-CPP group had higher serum levels of IGF-1, Klotho, and FGF23 than those in the SP-CPP and control groups(Table 2).
Table 2
Comparison of IGF-1, FGF23 and Klotho levels among all subjects
| n | IGF-1, ng/mL | Klotho, pg/mL | FGF23 pg/mL |
RP-CPP | 30 | 375.3 (281.98,416.2)a,b | 1950.81 (1875.65,2078.37) a,b | 42.30 (38.24,48.80) b,c |
SP-CPP | 31 | 269.4 (230.3,324.5) | 1773.84 (1731.96,1835.48) | 38.73 (34.73,42.66) |
control group | 28 | 207.45 (182.65,246.285) | 1657.74 (1498.75,1713.25) | 28.75 (27.21,33.55) |
p-value | | 0.000 | 0.000 | 0.000 |
a indicates statistical significance p < 0. 0001, compared with the SP-CPP group;b indicates statistical significance p < 0. 0001, compared with the control group༛c indicates statistical significance p < 0. 01, compared with the SP-CPP group.IGF-1, Insulin-like growth factor 1; FGF23, Fibroblast growth factor 23; RP-CPP, rapidly progressive central precocious puberty༛SP-CPP, slowly progressive central precocious puberty༛n, number; |
The Correlation Analysis Of Rp-cpp Predictors
In the RP-CPP group, serum Klotho level was significantly correlated with IGF-1, estradiol and LH (r = 0.668, r = 0.380, r = 0.538, P < 0.05); Serum FGF23 level was significantly correlated with IGF-1, LH base value and age (r = 0.64, r = 0.376, r = 0.741, P < 0.05, respectively). The specific correlation coefficients are shown in Table 3.
Table 3
Correlation analysis between relevant parameters in the RP-CPP group and Klotho and FGF23
| Klotho | | FGF23 |
r | p-value | | r | p-value |
IGF-1 | 0.668 | 0.000a | | 0.64 | 0.000 a |
E2 | 0.380 | 0.038 a | | 0.334 | 0.071 |
Basal LH | 0.538 | 0.002 a | | 0.376 | 0.041 a |
LH/FSH, Basal | 0.034 | 0.858 | | 0.245 | 0.191 |
LH/FSH, Peak | 0.338 | 0.068 | | 0.199 | 0.532 |
Height SDS | 0.051 | 0.787 | | 0.197 | 0.297 |
BMI SDS | 0.099 | 0.604 | | -0.156 | 0.409 |
BAI | -0.11 | 0.562 | | -0.288 | 0.123 |
CA | 0.313 | 0.093 | | 0.741 | 0.000 a |
Ovarian volume | 0.119 | 0.533 | | 0.293 | 0.116 |
a indicates statistical significance(p༜0.05), IGF-1, Insulin-like growth factor 1; FGF23, Fibroblast growth factor 23; E2, estradiol; LH, luteinizing hormone; FSH, follicle stimulating hormone; BMI, body mass index; SDS, standard deviation score; BAI, bone age index; CA, chronological age.
Roc Curve Results Of Rp-cpp Early Warning Indicators
The AUC of FGF23 was 0.685 ( P < 0.05 ), the cut-off value was 36.89pg/mL, and the specificity and sensitivity were 0.867 and 0.419, respectively. The AUC of Klotho was 0.829 ( P < 0.05 ), the cut-off value was 1882pg/mL, and the specificity and sensitivity were 0.767 and 0.936, respectively. The AUC of IGF-1 was 0.809 ( P < 0.05 ), the cut-off value was 256.7 ng / mL, the specificity was 0.967, and the sensitivity was 0.484. The AUC of basal LH was 0.931 ( P < 0.05 ), and the cut-off value was 0.55 IU / L. The specificity of this cut-off value was 0.867 and the sensitivity was 0.839. The AUC was 0.946 when basal LH and Klotho were combined. (Table 4 and Fig. 1)
Table 4
| AUC | 95%CI | p-Value | Cut-off | Sensitivity | Specificity | Youden |
FGF23(pg/mL) | 0.685 | (0.551,0.819) | 0.013 | 36.89 | 0.419 | 0.867 | 0.286 |
Klotho(pg/mL) | 0.829 | (0.713,0.945) | < 0.000 | 1882 | 0.936 | 0.767 | 0.702 |
IGF-1(ng/mL) | 0.809 | (0.704,0.914) | < 0.000 | 257.6 | 0.484 | 0.967 | 0.451 |
Basal LH(IU/L) | 0.931 | (0.872,0.989) | < 0.000 | 0.55 | 0.839 | 0.867 | 0.705 |
Klotho combined Basal LH | 0.946 | (0.895,0.997) | < 0.000 | - | - | - | - |
ROC, receiver operating characteristic; IGF-1, insulin-like growth factor-1; LH, luteinizing hormone; FGF23, Fibroblast growth factor 23; AUC, the area under the curve; CI confidence interval.