三维超声成像用于诊断性早熟女童
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摘要
目的探讨三维超声成像在女童性早熟诊断中的应用价值。方法对32例临床确诊为中枢性性早熟女童分别行二维、三维盆腔超声检查,记录子宫、卵巢体积,卵泡数目,最大卵泡直径及卵巢血流参数,并检测其血清黄体生成素(LH)、卵泡刺激素(FSH)基础水平及雌二醇(E_2)。比较二维与三维超声的测量参数差异,分析超声测量参数与激素水平的相关性。结果三维超声能清晰显示子宫及卵巢内部结构,三维超声测量直径>4 mm的卵泡数目和最大卵泡直径均大于二维超声(P均<0.01),三维超声测量子宫和卵巢体积与二维超声差异均无统计学意义(P均>0.05)。三维超声卵巢彩色血流显示率为87.50%(28/32),明显优于二维超声[28.12%(9/32),P<0.01)。三维超声能量多普勒血管指数(VI)、血流指数(FI)、血管血流指数(VFI)与最大卵泡直径均呈正相关(r=0.43、0.44、0.54,P均<0.05)。三维超声测量卵巢体积、最大卵泡直径与血清LH(r=0.39、0.72)、FSH(r=0.38、0.64)呈正相关(P均<0.05)。结论三维超声在性早熟女童中计数卵泡数目、测量最大卵泡直径及显示卵巢血供方面优于二维超声,有望在诊断女童性早熟中发挥重要作用。
Objective To investigate the value of three-dimensional ultrasonography(3D-US) in diagnosis of precocious puberty in girls. Methods Totally 32 girls diagnosed as central precocious were enrolled. Two-dimensional ultrasonography(2D-US) and 3D-US of pelvis were performed, and the volume of uterus and ovary, the number of follicles, the maximum follicle diameter and ovarian blood flow parameters were recorded. At the same time, the basic levels of serum luteinizing hormone(LH), follicle-stimulating hormone(FSH) and estradiol(E_2) were detected. The parameters measured with 2D-US and 3D-US were compared, and the correlation between ultrasonic measurement parameters and hormone level was also analyzed. Results 3D-US could clearly show the internal structure of uterus and ovary. The number of follicles larger than 4 mm and the maximum follicle diameter measured with 3D-US were all greater than those with 2D-US(both P<0.01), but no significant difference of the volume of uterus nor ovary was found between 2D-US and 3D-US measurements(both P>0.05). The color blood flow display rate of ovary in 3D-US was 87.50%(28/32), significantly better than that of 2D-US(28.12% [9/32], P<0.01). 3D-US energy Doppler vascular index(VI), blood flow index(FI), blood vessel-blood flow index(VFI) were positively correlated with the maximum follicle diameter(r=0.43, 0.44, 0.54, all P<0.05). 3D-US measurements of ovarian volume and maximum follicle diameters were positively correlated with the serum LH(r=0.39, 0.72) and FSH(r=0.38, 0.64, all P<0.05). Conclusion 3D-US is superior to 2D-US in counting follicles, measuring the maximum follicle diameter and showing ovarian blood supply in precocious girls, and is expected to play an important role in the diagnosis of precocious puberty in girls.
Objective To investigate the value of three-dimensional ultrasonography(3D-US) in diagnosis of precocious puberty in girls. Methods Totally 32 girls diagnosed as central precocious were enrolled. Two-dimensional ultrasonography(2D-US) and 3D-US of pelvis were performed, and the volume of uterus and ovary, the number of follicles, the maximum follicle diameter and ovarian blood flow parameters were recorded. At the same time, the basic levels of serum luteinizing hormone(LH), follicle-stimulating hormone(FSH) and estradiol(E_2) were detected. The parameters measured with 2D-US and 3D-US were compared, and the correlation between ultrasonic measurement parameters and hormone level was also analyzed. Results 3D-US could clearly show the internal structure of uterus and ovary. The number of follicles larger than 4 mm and the maximum follicle diameter measured with 3D-US were all greater than those with 2D-US(both P<0.01), but no significant difference of the volume of uterus nor ovary was found between 2D-US and 3D-US measurements(both P>0.05). The color blood flow display rate of ovary in 3D-US was 87.50%(28/32), significantly better than that of 2D-US(28.12% [9/32], P<0.01). 3D-US energy Doppler vascular index(VI), blood flow index(FI), blood vessel-blood flow index(VFI) were positively correlated with the maximum follicle diameter(r=0.43, 0.44, 0.54, all P<0.05). 3D-US measurements of ovarian volume and maximum follicle diameters were positively correlated with the serum LH(r=0.39, 0.72) and FSH(r=0.38, 0.64, all P<0.05). Conclusion 3D-US is superior to 2D-US in counting follicles, measuring the maximum follicle diameter and showing ovarian blood supply in precocious girls, and is expected to play an important role in the diagnosis of precocious puberty in girls.
引文
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[11] Lee SH,Joo EY,Lee JE,et al.The diagnostic value of pelvic ultrasound in girls with central precocious puberty.Chonnam Med J,2016,52(1):70-74.
[12] 王华,孙蕾,余珊珊,等.女童性早熟的超声诊断应用研究.中国儿童保健杂志,2018,26(7):784-786.
[13] 毛书霞,张玫玫,强也,等.三维超声在妇科中的应用进展.临床超声医学杂志,2017,19(1):41-43.
[14] Kupesic S,Kurjak A,Bjelos D,et al.Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age.Fertil Steril,2003,79(1):190-197.
[15] Lam PM,Johnson IR,Raine-Fenning NJ.Three-dimensional ultrasound features of the polycystic ovary and the effect of different phenotypic expressions on these parameters.Hum Reprod,2007,22(12):3116-3123.
[16] Stachowicz N,Czekierdowski A,Danilos J,et al.Three-dimensional sonoangiography in diagnostic of endometrial hyperplasia and carcinoma.An assessment of vascularization indices and endometrial volume.Przegl Lek,2005,62 (9):827-829.
[17] 盛林,梁萍,董宝玮.三维超声体积精测在临床中的应用.中华超声影像学杂志,2005,14(1):70-73.
[18] Kyei-Mensah A,Zaidi J,Pittrof R,et al.Transvaginal three-dimensional ultrasound:Accuracy of follicular volume measurements.Fertil Steril,1996,65(2):371-376.
[2] 刘月影,马亚萍,金祉延,等.家庭环境和教养方式对女童特发性中枢性性早熟的影响.中国学校卫生,2016,37(9):1406-1408.
[3] 何毅,钟燕,赵莎,等.肥胖儿童性早熟的相关危险因素分析研究.医学临床研究,2016,33(2):381-383.
[4] Euling SY,Selevan SG,Pescovitz OH,et al.Role of environmental factors in the timing of puberty.Pediatrics,2008,121(Suppl 3):S167-S171.
[5] 中华预防医学会妇女保健分会青春期学组.女性性早熟的诊治共识.中国妇幼健康研究,2018,29(2):135-138.
[6] Mogensen SS,Aksglaede L,Mouritsen A,et al.Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty.J Clin Endocrinol Metabol,2011,96(5):1393-1401.
[7] 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.中国当代儿科杂志,2012,14(12):942-945.
[8] 张小君,魏双梅.血清促性腺激素基础值在性早熟女童诊断中的应用.中国民康医学,2015,27(6):71-72.
[9] Salardi S,Orsini LF,Cacciari E,et al.Pelvic ultrasonography in girls with precocious puberty,congenital adrenal hyperplasia,obesity,or hirsutism.J Pediatr,1988,112(6):880-887.
[10] Stanhope R,Abdulwahid NA,Adams J,et al.Studies of gonadotrophin pulsatility and pelvic ultrasound examinations distinguish between isolated premature thelarche and central precocious puberty.Eur J Pediatr,1986,145(3):190-194.
[11] Lee SH,Joo EY,Lee JE,et al.The diagnostic value of pelvic ultrasound in girls with central precocious puberty.Chonnam Med J,2016,52(1):70-74.
[12] 王华,孙蕾,余珊珊,等.女童性早熟的超声诊断应用研究.中国儿童保健杂志,2018,26(7):784-786.
[13] 毛书霞,张玫玫,强也,等.三维超声在妇科中的应用进展.临床超声医学杂志,2017,19(1):41-43.
[14] Kupesic S,Kurjak A,Bjelos D,et al.Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age.Fertil Steril,2003,79(1):190-197.
[15] Lam PM,Johnson IR,Raine-Fenning NJ.Three-dimensional ultrasound features of the polycystic ovary and the effect of different phenotypic expressions on these parameters.Hum Reprod,2007,22(12):3116-3123.
[16] Stachowicz N,Czekierdowski A,Danilos J,et al.Three-dimensional sonoangiography in diagnostic of endometrial hyperplasia and carcinoma.An assessment of vascularization indices and endometrial volume.Przegl Lek,2005,62 (9):827-829.
[17] 盛林,梁萍,董宝玮.三维超声体积精测在临床中的应用.中华超声影像学杂志,2005,14(1):70-73.
[18] Kyei-Mensah A,Zaidi J,Pittrof R,et al.Transvaginal three-dimensional ultrasound:Accuracy of follicular volume measurements.Fertil Steril,1996,65(2):371-376.