女性儿童特发性性早熟的临床特点和相关性因素的研究
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摘要
目的对特发性性早熟(ICPP)女童的临床特点和发病的相关性因素进行探讨,为临床诊断和治疗提供科学的依据。方法选择2014年1月—2015年3月南通大学附属海安医院儿科收治的ICPP女童45例作为研究组,选择同龄的45例正常女童作为对照组,观察和检测2组女童的一般临床特征、生理性指标、性激素水平和发病影响因素等,进行比较和分析。结果 ICPP女童乳房发育和月经初潮的平均年龄为(7.5±0.4)岁和(9.3±0.5)岁,比正常女童提前了1~3 a。ICPP女童的身高、体质指数(BMI)、瘦素、骨龄(BA)、卵巢容积、子宫容积和乳晕直径等生理性指标,均明显高于对照组女童,差异有统计学意义(P<0.05)。ICPP女童的卵泡刺激素(FSH)和黄体生成素(LH)的基础值与对照组相比较,差异无统计学意义(P>0.05);但在FSH和LH的峰值、雌二醇(E2)、垂体催乳素(PRL)和孕酮(P)等性激素水平方面,差异有统计学意义(P<0.05)。ICPP女童的生理、环境、饮食、遗传和家庭等发病率影响因素方面,与对照组相比,差异无统计学意义(P>0.05)。结论 ICPP女童的乳房发育和月经初潮年龄提前,与BMI、身高和瘦素水平明显增加,卵巢、子宫和乳房发育明显提前,FSH和LH的峰值、E2、PRL和P等性激素水平显著升高,呈明显的正相关;该研究因调查样本量小,尚不能说明ICPP女童的发病与生理、环境、饮食、遗传和家庭因素等有明显的关系。提示社会各方应重视和加强对儿童的心理和生殖健康的教育,促进其身心健康的发展;对性早熟患儿应早期发现和早期诊断,尽早给予积极有效的综合治疗,减少性早熟对患儿的不良影响。
[Objective] To explore the clinical characteristics and relevant factors of female children with Idiopathic Central Precocious Puberty(ICPP),provide the scientific basis for clinical diagnosis and treatment.[Methods]45 cases of girls with ICPP who were treated in the Department of Pediatrics in Haian Hospital affiliated of Nantong University from January 2014 to March 2015 were chosen as the study group,and 45 normal girls with the same age were enrolled in the control group.The general clinical features,physiological indicators,sex hormones level and influencing factors in two groups were compared and analyzed.[Results]The average age of breast development and menarche of girls with ICPP was(7.5±0.4)years old and(9.3±0.5)years old,which were earlier than normal girls by 1-3 years.Height,body mass index(BMI),leptin,bone age(BA),volume of the ovaries,uterus volume,areola diameter and other physiological indicators of girls with ICPP were all higher than those of girls in the control group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the basis values of follicule-stimulating hormone(FSH)and luteinizing hormone(LH)between the study group and the control group(P>0.05).However,the differences in the peak values of FSH and LH and the levels of sex hormone,including estradiol(E2),pituitary prolactin(PRL)and progesterone(P),were statistically significant between two groups(P<0.05).There were no statistically significant differences in physiological,environmental,dietary,genetic and familial factors affecting the incidence rate between two groups(P >0.05).[Conclusion] Breast development and menarche are earlier in girls with ICPP,which are significantly positively correlated with the increased levels of BMI,height and leptin,while the development of ovary,uterus and breast are significantly earlier,which are significantly positively correlated with the increased peak values of FSH and LH and the increased levels of sex hormone(including E2,PRL and P).Because the study sample size is too small,it cannot be regarded that there is a significant relationship between ICPP and physiological,environmental,dietary,genetic and family factors.The society should pay attention to strengthen the children's mental and reproductive health education,to promote their physical and mental health development,implement the early detection and early diagnosis for ICPP children,and give the positive and effective treatment,to reduce the adverse effects of precocious puberty in children.
[Objective] To explore the clinical characteristics and relevant factors of female children with Idiopathic Central Precocious Puberty(ICPP),provide the scientific basis for clinical diagnosis and treatment.[Methods]45 cases of girls with ICPP who were treated in the Department of Pediatrics in Haian Hospital affiliated of Nantong University from January 2014 to March 2015 were chosen as the study group,and 45 normal girls with the same age were enrolled in the control group.The general clinical features,physiological indicators,sex hormones level and influencing factors in two groups were compared and analyzed.[Results]The average age of breast development and menarche of girls with ICPP was(7.5±0.4)years old and(9.3±0.5)years old,which were earlier than normal girls by 1-3 years.Height,body mass index(BMI),leptin,bone age(BA),volume of the ovaries,uterus volume,areola diameter and other physiological indicators of girls with ICPP were all higher than those of girls in the control group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the basis values of follicule-stimulating hormone(FSH)and luteinizing hormone(LH)between the study group and the control group(P>0.05).However,the differences in the peak values of FSH and LH and the levels of sex hormone,including estradiol(E2),pituitary prolactin(PRL)and progesterone(P),were statistically significant between two groups(P<0.05).There were no statistically significant differences in physiological,environmental,dietary,genetic and familial factors affecting the incidence rate between two groups(P >0.05).[Conclusion] Breast development and menarche are earlier in girls with ICPP,which are significantly positively correlated with the increased levels of BMI,height and leptin,while the development of ovary,uterus and breast are significantly earlier,which are significantly positively correlated with the increased peak values of FSH and LH and the increased levels of sex hormone(including E2,PRL and P).Because the study sample size is too small,it cannot be regarded that there is a significant relationship between ICPP and physiological,environmental,dietary,genetic and family factors.The society should pay attention to strengthen the children's mental and reproductive health education,to promote their physical and mental health development,implement the early detection and early diagnosis for ICPP children,and give the positive and effective treatment,to reduce the adverse effects of precocious puberty in children.
引文
[1]中华医学会儿科学分会内分泌遗传代谢学组.中枢性(真性)性早熟诊治指南[J].中华儿科杂志,2007,45(6):426-427.
[2]杨素红,顾再研,刘建迪.性早熟女童60例骨龄指数分析[J].浙江中西医结合杂志,2012,22(5):375-377.
[3]王卫平.儿科学[M].8版.北京:人民卫生出版社,2013:426-429.
[4]LEE HS,PARK HK,KO JH,et al.Utility of basalluteinizing hormone levels for detecting central precocious puberty in girls[J].Horm Metab Res,2012,44(11):851-854.
[5]周敏,吴冬梅.儿童性早熟的相关研究[J].中国医药导报,2011,8(4):141-142.
[6]华英,杨箐岩,刘戈力,等.骨龄指数在儿童性早熟诊断中的临床意义[J].天津医药,2012,40(5):430-432.
[7]卫海燕,陈永兴,李春枝,等.郑州地区3~12岁儿童性早熟流行病学调查[J].实用儿科杂志,2010,25(20):1568-1570.
[8]SOLORZANO CB,MCCARTNEY CR;Obesity and the pubertal transition in girls and boys[J].Reproduction.2010,140(3):399-410.
[9]曾理,胡晶,马继斌.超声辅助检查在女童特发性真、假性性早熟鉴别诊断中的作用分析[J].中国性科学,2014,23(11):44-46.
[10]曹媛.超声子宫及卵巢大小在性早熟女童中应用价值[J].安徽医学,2014,35(11):1503-1505.
[11]梁进涛.血清促性腺激素基础值在性早熟女童诊断中的价值[J].中国当代儿科杂志,2012,14(12):942-945.
[12]冯玉贞.儿童期性早熟42例临床分析[J].临床和实验医学杂志,2011,10(3):189-190.
[13]晏国娟.儿童性早熟相关因素研究[J].临床荟萃,2013,28(6):719-721.
[14]O ZEN S,DARCAN S.Effects of environmental endocrine disruptors on pubertal development[J].J Clin Res Pediatr Endocrinol,2011,3(1):1-6.
[15]龙萧萌,单川,沈秀华.儿童肥胖与性早熟的研究进展[J].上海交通大学学报(医学版),2012,32(7):949-951.
[16]武俊青,戎芬,李玉艳,等.无锡市10~14岁儿童超重肥胖现状调查及影响因素分析[J].卫生研究,2012,41(5):743-747.
[17]柯江维,段荣.性早熟和性早熟危险因素研究进展[J].实验与检验医学,2012,30(3):243-247.
[18]邓英华,冯承芸,牛丽,等.宝安区4~10岁儿童性早熟现状调查及相关性因素分析[J].中国妇幼保健,2014,29(11):1723-1725.
[19]胡敏,潘未未.知柏地黄丸与大补阴丸联合治疗中枢性性早熟患儿的临床效果分析[J].中国性科学,2015,24(3):76-78.
[20]黄蓉,汪永红,俞建.中医治疗儿童性早熟辩证用药规律探析[J].中华中医药杂志,2011,26(2):347-349.
[2]杨素红,顾再研,刘建迪.性早熟女童60例骨龄指数分析[J].浙江中西医结合杂志,2012,22(5):375-377.
[3]王卫平.儿科学[M].8版.北京:人民卫生出版社,2013:426-429.
[4]LEE HS,PARK HK,KO JH,et al.Utility of basalluteinizing hormone levels for detecting central precocious puberty in girls[J].Horm Metab Res,2012,44(11):851-854.
[5]周敏,吴冬梅.儿童性早熟的相关研究[J].中国医药导报,2011,8(4):141-142.
[6]华英,杨箐岩,刘戈力,等.骨龄指数在儿童性早熟诊断中的临床意义[J].天津医药,2012,40(5):430-432.
[7]卫海燕,陈永兴,李春枝,等.郑州地区3~12岁儿童性早熟流行病学调查[J].实用儿科杂志,2010,25(20):1568-1570.
[8]SOLORZANO CB,MCCARTNEY CR;Obesity and the pubertal transition in girls and boys[J].Reproduction.2010,140(3):399-410.
[9]曾理,胡晶,马继斌.超声辅助检查在女童特发性真、假性性早熟鉴别诊断中的作用分析[J].中国性科学,2014,23(11):44-46.
[10]曹媛.超声子宫及卵巢大小在性早熟女童中应用价值[J].安徽医学,2014,35(11):1503-1505.
[11]梁进涛.血清促性腺激素基础值在性早熟女童诊断中的价值[J].中国当代儿科杂志,2012,14(12):942-945.
[12]冯玉贞.儿童期性早熟42例临床分析[J].临床和实验医学杂志,2011,10(3):189-190.
[13]晏国娟.儿童性早熟相关因素研究[J].临床荟萃,2013,28(6):719-721.
[14]O ZEN S,DARCAN S.Effects of environmental endocrine disruptors on pubertal development[J].J Clin Res Pediatr Endocrinol,2011,3(1):1-6.
[15]龙萧萌,单川,沈秀华.儿童肥胖与性早熟的研究进展[J].上海交通大学学报(医学版),2012,32(7):949-951.
[16]武俊青,戎芬,李玉艳,等.无锡市10~14岁儿童超重肥胖现状调查及影响因素分析[J].卫生研究,2012,41(5):743-747.
[17]柯江维,段荣.性早熟和性早熟危险因素研究进展[J].实验与检验医学,2012,30(3):243-247.
[18]邓英华,冯承芸,牛丽,等.宝安区4~10岁儿童性早熟现状调查及相关性因素分析[J].中国妇幼保健,2014,29(11):1723-1725.
[19]胡敏,潘未未.知柏地黄丸与大补阴丸联合治疗中枢性性早熟患儿的临床效果分析[J].中国性科学,2015,24(3):76-78.
[20]黄蓉,汪永红,俞建.中医治疗儿童性早熟辩证用药规律探析[J].中华中医药杂志,2011,26(2):347-349.