特发性中枢性性早熟对比单纯乳房发育女童垂体发育及性激素表达临床差异性分析
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摘要
目的分析特发性中枢性性早熟(ICPP)对比单纯乳房发育(PT)女童垂体发育及性激素表达临床差异性。方法选取2015年1月至2017年12月无锡市儿童医院和江苏省人民医院诊治的乳房增大患儿102例作为研究对象。依据《性早熟诊疗指南》内诊断标准将其分成ICPP组与PT组,其中ICPP组52例,PT组50例。同时选取同期在无锡市儿童医院和江苏省人民医院体检的健康女童50例作为对照组。对比患儿青春发育情况、血清激素指标水平、MRI检测患儿垂体高度、垂体形态等状况。结果 52例ICPP患儿中乳房发育(均按照Tanner分期标准)B2期6例、B3期34例、B4期8例、B5期4例,阴毛发育PHⅠ期10例、PHⅡ期29例、PHⅢ期9例、PHⅣ期4例,月经来潮13例,患儿子宫卵巢B超显示子宫容积变大37例,卵巢发育34例,患儿骨龄(8.42±1.29)岁;50例PT患儿乳房发育B2期29例、B3期21例,无月经来潮和阴毛萌出者,患儿子宫卵巢B超显示子宫容积增大9例,卵巢发育7例,患儿骨龄(7.29±1.22)岁。三组对象血清E_2水平、LH峰值、LH基础值和LH峰值/FSH峰值对比差异均具有统计学意义(均P<0.05),ICPP组各项指标均高于PT组;LH峰值/FSH峰值高于0.60、LH峰值高于5.10mIU/ml时,诊断ICPP与PT特异度是99.10%,敏感度是98.21%;ICPP组患儿垂体高度和垂体形态Ⅳ至Ⅴ级比PT组高,差异均具有统计学意义(均P<0.05)。结论 ICPP患儿血清性激素水平及垂体高度和垂体形态高于PT患儿。
Objective To analyze the clinical difference in the development of pituitary gland and the expression of sex hormone between girls with idiopathic central precocious puberty(ICPP) and premature thelarche(PT). Methods 102 girls diagnosed with breast enlargement in Wuxi Children′s Hospital and Jiangsu Province People′s Hospital from January 2015 to December 2017 were selected and, according to Guidelines in Precocious Diagnostic Criteria, were divided into ICPP group(n=52) and PT group(n=50). Another 50 healthy girls went to the hospital for physical examination at the same time were selected as the control group. The puberty development, serum hormone levels and pituitary height and morphology detected by MRI were compared. Results Among the 52 children with ICPP, there were 6 cases at stage B2, 34 cases at stage B3, 8 cases at stage B4 and 4 cases at stage B5 according to the breast development(the Tanner criteria); there were 10 cases at PH stage I, 29 cases at PH stage II, 9 cases at PH stage III and 4 cases at PH stage IV according to the development of pubes hair; there were 13 cases with menses, 37 cases with enlarged uterine volume according to uterine and ovarian ultrasound, 34 cases with ovarian development. The average skeletal age of the 52 children with ICPP was(8.42±1.29) years old. Among the 50 patients with PT, there were 29 cases at stage B2 and 21 cases at stage B3 according to the breast development(the Tanner criteria); there was no patients with menses or pubes hair; there were 9 cases with enlarged uterine volume according to uterine and ovarian ultrasound, 7 cases with ovarian development. The average skeletal age of the 50 children with PT was(7.29±1.22) years old. There were statistically significant differences in the serum E_2 level, LH peak, LH basic values and ratio of LH peak to FSH peak among the three groups(P < 0.05). The indexes of ICPP group were higher than those of PT group. When the ratio of LH peak to FSH peak was above 0.60 and the peak value of LH was higher than 5.10 mIU/ml, the ICPP and PT diagnostic specificity and sensitivity was 99.10% and 98.21% respectively. The pituitary height and pituitary morphology of stage IV to V in ICPP group was significantly higher than that of the PT group, with statistically significant differences(P<0.05). Conclusions The levels of serum sex hormones and pituitary height and pituitary morphology in children with ICPP were higher than those in children with PT.
Objective To analyze the clinical difference in the development of pituitary gland and the expression of sex hormone between girls with idiopathic central precocious puberty(ICPP) and premature thelarche(PT). Methods 102 girls diagnosed with breast enlargement in Wuxi Children′s Hospital and Jiangsu Province People′s Hospital from January 2015 to December 2017 were selected and, according to Guidelines in Precocious Diagnostic Criteria, were divided into ICPP group(n=52) and PT group(n=50). Another 50 healthy girls went to the hospital for physical examination at the same time were selected as the control group. The puberty development, serum hormone levels and pituitary height and morphology detected by MRI were compared. Results Among the 52 children with ICPP, there were 6 cases at stage B2, 34 cases at stage B3, 8 cases at stage B4 and 4 cases at stage B5 according to the breast development(the Tanner criteria); there were 10 cases at PH stage I, 29 cases at PH stage II, 9 cases at PH stage III and 4 cases at PH stage IV according to the development of pubes hair; there were 13 cases with menses, 37 cases with enlarged uterine volume according to uterine and ovarian ultrasound, 34 cases with ovarian development. The average skeletal age of the 52 children with ICPP was(8.42±1.29) years old. Among the 50 patients with PT, there were 29 cases at stage B2 and 21 cases at stage B3 according to the breast development(the Tanner criteria); there was no patients with menses or pubes hair; there were 9 cases with enlarged uterine volume according to uterine and ovarian ultrasound, 7 cases with ovarian development. The average skeletal age of the 50 children with PT was(7.29±1.22) years old. There were statistically significant differences in the serum E_2 level, LH peak, LH basic values and ratio of LH peak to FSH peak among the three groups(P < 0.05). The indexes of ICPP group were higher than those of PT group. When the ratio of LH peak to FSH peak was above 0.60 and the peak value of LH was higher than 5.10 mIU/ml, the ICPP and PT diagnostic specificity and sensitivity was 99.10% and 98.21% respectively. The pituitary height and pituitary morphology of stage IV to V in ICPP group was significantly higher than that of the PT group, with statistically significant differences(P<0.05). Conclusions The levels of serum sex hormones and pituitary height and pituitary morphology in children with ICPP were higher than those in children with PT.
引文
[1] 白玲, 唐华, 张燕,等.特发性中枢性性早熟和单纯乳房早发育体内血清铁的变化[J].中国妇幼保健, 2015, 30(4):556-557.
[2] 葛青玮, 朱志颖.血清LH峰值、IGF-1和IGF-BP3水平在特发性中枢性性早熟中的诊断价值[J].临床和实验医学杂志, 2015,17(24):2072-2074.
[3] 郭兰芳, 杨铱, 周梦婕,等.特发性中枢性性早熟女性患儿血浆中Kisspeptin及骨钙素水平研究[J].中国妇幼保健, 2015, 30(34):6023-6025.
[4] ?atl? G, Erdem P, An?k A, et al.Clinical and laboratory findings in the differential diagnosis of central precocious puberty and premature thelarche[J].Turkish Archives of Pediatrics/türk Pediatri Ar?ivi, 2015, 50(1):20-23.
[5] 中华人民共和国卫生部.性早熟诊疗指南(试行)[卫办医政发(195)号][J].中国儿童保健杂志, 2011, 19(4):390-392.
[6] Abac? A, ?atl? G, An?k A, et al.Significance of serum neurokinin B and kisspeptin levels in the differential diagnosis of premature thelarche and idiopathic central precocious puberty[J].Peptides, 2015, 64(13):29-33.
[7] 林翠兰, 韦婉俭, 何婉懿,等.促性腺激素释放激素类似物对特发性中枢性性早熟女童促生长素轴与生长速度的影响[J].中国儿童保健杂志, 2016, 24(1):65-68.
[8] 吴慧平, 金献江, 罗越,等.血清基质金属蛋白酶2与骨代谢标志物水平对女童特发性中枢性性早熟的诊断价值研究[J].中国全科医学, 2015,7(11):1264-1269.
[9] Arcari AJ,Gryngarten MG,Freire AV, et al.Body mass index in girls with idiopathic central precocious puberty during and after treatment with GnRH analogues[J].International Journal of Pediatric Endocrinology, 2016, 16(1):15-19.
[10] 刘月影, 马亚萍, 金祉延,等.特发性中枢性性早熟女童生活质量与自我意识的相关性研究[J].中华行为医学与脑科学杂志, 2015, 24(2):139-141.
[11] 张瑞杰, 张德甫, 程美英.特发性性早熟女童的磁共振脑垂体影像特征分析[J].中国妇幼保健, 2015, 30(32):5592-5594.
[12] Shima H, Yatsuga S, Nakamura A, et al.NR0B1 frameshift mutation in a boy with idiopathic central precocious puberty[J].Sex Dev, 2016, 10(4):205-209.
[13] 张红红, 陶娜, 祁建勤,等.昆明地区学龄前女童同性性早熟病因及临床特点分析[J].昆明医科大学学报, 2015, 36(3):142-145.
[14] Leka-Emiri S, Chrousos GP, Kanaka-Gantenbein C.The mystery of puberty initiation:genetics and epigenetics of idiopathic central precocious puberty (ICPP) [J].Journal of Endocrinological Investigation, 2017, 40(8):789-793.
[15] 王莉菁, 蒋键波, 方兴.醋酸曲普瑞林治疗特发性中枢性早熟临床效果观察[J].中国性科学, 2015,24(10):14-16.
[16] 吴慧平, 金献江, 罗越,等.骨代谢标志物在特发性中枢性性早熟女童血清中的变化及意义[J].浙江医学, 2015, 37(16):1347-1349.
[17] Nacinovich R, Buzi F, Oggiano S, et al.Body experiences and psychopathology in idiopathic central precocious and early puberty[J].Minerva Pediatrica, 2016, 68(1):11-15.
[18] 祁荟桔, 张学源, 项蓉.中西医结合治疗女童特发性中枢性性早熟36例临床分析[J].天津中医药大学学报, 2016, 35(2):88-91.
[2] 葛青玮, 朱志颖.血清LH峰值、IGF-1和IGF-BP3水平在特发性中枢性性早熟中的诊断价值[J].临床和实验医学杂志, 2015,17(24):2072-2074.
[3] 郭兰芳, 杨铱, 周梦婕,等.特发性中枢性性早熟女性患儿血浆中Kisspeptin及骨钙素水平研究[J].中国妇幼保健, 2015, 30(34):6023-6025.
[4] ?atl? G, Erdem P, An?k A, et al.Clinical and laboratory findings in the differential diagnosis of central precocious puberty and premature thelarche[J].Turkish Archives of Pediatrics/türk Pediatri Ar?ivi, 2015, 50(1):20-23.
[5] 中华人民共和国卫生部.性早熟诊疗指南(试行)[卫办医政发(195)号][J].中国儿童保健杂志, 2011, 19(4):390-392.
[6] Abac? A, ?atl? G, An?k A, et al.Significance of serum neurokinin B and kisspeptin levels in the differential diagnosis of premature thelarche and idiopathic central precocious puberty[J].Peptides, 2015, 64(13):29-33.
[7] 林翠兰, 韦婉俭, 何婉懿,等.促性腺激素释放激素类似物对特发性中枢性性早熟女童促生长素轴与生长速度的影响[J].中国儿童保健杂志, 2016, 24(1):65-68.
[8] 吴慧平, 金献江, 罗越,等.血清基质金属蛋白酶2与骨代谢标志物水平对女童特发性中枢性性早熟的诊断价值研究[J].中国全科医学, 2015,7(11):1264-1269.
[9] Arcari AJ,Gryngarten MG,Freire AV, et al.Body mass index in girls with idiopathic central precocious puberty during and after treatment with GnRH analogues[J].International Journal of Pediatric Endocrinology, 2016, 16(1):15-19.
[10] 刘月影, 马亚萍, 金祉延,等.特发性中枢性性早熟女童生活质量与自我意识的相关性研究[J].中华行为医学与脑科学杂志, 2015, 24(2):139-141.
[11] 张瑞杰, 张德甫, 程美英.特发性性早熟女童的磁共振脑垂体影像特征分析[J].中国妇幼保健, 2015, 30(32):5592-5594.
[12] Shima H, Yatsuga S, Nakamura A, et al.NR0B1 frameshift mutation in a boy with idiopathic central precocious puberty[J].Sex Dev, 2016, 10(4):205-209.
[13] 张红红, 陶娜, 祁建勤,等.昆明地区学龄前女童同性性早熟病因及临床特点分析[J].昆明医科大学学报, 2015, 36(3):142-145.
[14] Leka-Emiri S, Chrousos GP, Kanaka-Gantenbein C.The mystery of puberty initiation:genetics and epigenetics of idiopathic central precocious puberty (ICPP) [J].Journal of Endocrinological Investigation, 2017, 40(8):789-793.
[15] 王莉菁, 蒋键波, 方兴.醋酸曲普瑞林治疗特发性中枢性早熟临床效果观察[J].中国性科学, 2015,24(10):14-16.
[16] 吴慧平, 金献江, 罗越,等.骨代谢标志物在特发性中枢性性早熟女童血清中的变化及意义[J].浙江医学, 2015, 37(16):1347-1349.
[17] Nacinovich R, Buzi F, Oggiano S, et al.Body experiences and psychopathology in idiopathic central precocious and early puberty[J].Minerva Pediatrica, 2016, 68(1):11-15.
[18] 祁荟桔, 张学源, 项蓉.中西医结合治疗女童特发性中枢性性早熟36例临床分析[J].天津中医药大学学报, 2016, 35(2):88-91.