小于8岁性早熟女童阴道出血的病因分析
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摘要
目的:研究小于8岁性早熟女童阴道出血的病因。方法:对宁波市北仑区小港医院儿科2014年1月到2016年12月收治的68例小于8岁性早熟女童的临床资料进行回顾性分析,对所有患儿的病史进行详细询问,对其进行身高,体重,乳房,外阴等项目的体检,并对其骨龄片进行摄取,并对其进行B超检查,主要对其卵巢,子宫进行扫描,对其进行头颅MRI检查,LHRH激发试验,运用化学发光法检测其PRL,FSH,E2,T水平。结果:68例患儿中,54例为假性性早熟,其中24例为外源性性早熟,18例为卵巢囊肿,12例病因不明,分别占44.4%,33.3%,22.2%;14例为真性性早熟,分别占总数的79.4%,20.6%。假性性早熟患儿中外源性性早熟,卵巢囊肿患儿均有一定程度的色素沉着在乳晕及外阴,而和假性性早熟患儿相比,真性性早熟患儿具有显著较大的乳房发育,同时外阴阴唇阴蒂均已发育。结论:小于8岁性早熟女童阴道出血的病因主要为假性性早熟,而假性性早熟的病因主要为外源性性早熟,卵巢囊肿。临床应该依据病因及时给予患儿有针对性的治疗,从而将不良后果的发生几率降低到最低限度。
Objective: To study the etiology of vaginal bleeding in less than 8-year-oldgirls with precocious pu-berty. Methods: 68 girls who were less than8 years old with precocious puberty treated in Department of Pediatrics of Beilun District Xiaogang Hospital of Ningbo from January 2014 to December 2016 were analyzed retrospectively. Medical history of all patients were taken in detail and physical examination was conducted to understand the details of height,weight,breast,vulva and other items. The bone age was tested. The patients receivedultrasound examination to scan ovary and uterus. Brain MRI examination and the LHRH excitation test were done. The PRL,FSH,E2 and T levels were detected by chemiluminescence detection. Results: Amongthe 68 patients,there were 54 cases ofpseudo precocious puberty,including 24 cases of exogenous precocious puberty,18 cases of ovarian cyst,and 12 cases of unknown etiology,accounting for 44. 4%,33. 3% and 22. 2% respectively. There were 14 cases of true precocious puberty,accounting for 20. 6%.Certain degrees of pigmentation on the areola and vulva occurred in patients with exogenous sexual precocity and ovarian cyst. Compared with pseudo precocious puberty,true precocious puberty children had significant breast development,and developed clitoris labium of vulva. Conclusions: The main etiology of vaginal bleeding in less than 8-year-old girls with precocious puberty are pseudo precocious puberty,and the main etiology of pseudo precocious puberty are exogenous precocious puberty and ovarian cysts. Targeted treatment should be taken in a timely manner based on the etiology of the disease,thereby reducing the incidence of adverse consequences of children to a minimum.
Objective: To study the etiology of vaginal bleeding in less than 8-year-oldgirls with precocious pu-berty. Methods: 68 girls who were less than8 years old with precocious puberty treated in Department of Pediatrics of Beilun District Xiaogang Hospital of Ningbo from January 2014 to December 2016 were analyzed retrospectively. Medical history of all patients were taken in detail and physical examination was conducted to understand the details of height,weight,breast,vulva and other items. The bone age was tested. The patients receivedultrasound examination to scan ovary and uterus. Brain MRI examination and the LHRH excitation test were done. The PRL,FSH,E2 and T levels were detected by chemiluminescence detection. Results: Amongthe 68 patients,there were 54 cases ofpseudo precocious puberty,including 24 cases of exogenous precocious puberty,18 cases of ovarian cyst,and 12 cases of unknown etiology,accounting for 44. 4%,33. 3% and 22. 2% respectively. There were 14 cases of true precocious puberty,accounting for 20. 6%.Certain degrees of pigmentation on the areola and vulva occurred in patients with exogenous sexual precocity and ovarian cyst. Compared with pseudo precocious puberty,true precocious puberty children had significant breast development,and developed clitoris labium of vulva. Conclusions: The main etiology of vaginal bleeding in less than 8-year-old girls with precocious puberty are pseudo precocious puberty,and the main etiology of pseudo precocious puberty are exogenous precocious puberty and ovarian cysts. Targeted treatment should be taken in a timely manner based on the etiology of the disease,thereby reducing the incidence of adverse consequences of children to a minimum.
引文
[1]中华医学会儿科学分会内分泌遗传代谢组.中枢性(真性)性早熟诊治指南.中华儿科杂志,2007,45(6):426-427.
[2]李筠,梁黎,孙莉颖,等.联合应用促性腺激素类似物和生长激素治疗女童初潮后特发性中枢性性早熟.中华儿科杂志,2011,23(436):54-56.
[3]杜敏联.对中枢性(真性)性早熟诊断和治疗的建议.中华儿科杂志,2012,42(5):478-479.
[4]朱顺叶,陈红珊,马华梅,等.蛋白同化类固醇激素对GnRHa治疗后中枢性性早熟患儿生长的影响.中国儿童保健杂志,2013,17(1):51-53.
[5]孙燕,崔朝晖.小于8岁性早熟女童阴道出血20例分析.中国儿童保健杂志,2013,21(8):65-68.
[6]马华梅,杜敏联.GnRHa联用rh GH治疗真性性早熟女孩的疗效评价.中华内分泌代谢杂志,2013,22(3):252-255.
[7]马华梅,杜敏联.特发性中枢性性早熟女孩血瘦素和胰岛素样生长因子1浓度测定的意义.中国实用儿科杂志,2012,16(7):417-419.
[8]顾威,沈卫星.玉米赤霉烯酮污染与儿童性早熟发病相关性研究进展.中华实用儿科临床杂志,2014,29(8):637-639.
[9]熊翔宇,杨玉.血浆Kisspeptin水平对女童中枢性性早熟的诊断及疗效评估的意义.中华实用儿科临床杂志,2014,29(8):612-615.
[10]冯海英,张蕾,周燕,等.曲普瑞林对特发性中枢性性早熟女童体质量指数及终身高的影响.中国基层医药,2014,21(7):979-981.
[11]章董萍,黄卫宇,赵奕.周围性性早熟36例临床分析.中国实用儿科杂志,2011,34(4):765-766.
[12]张琼,管玉涛,颜林志,等.幼女阴道流血103例分析.中国现代医生,2011,49(4):545-546.
[13]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因素分析.中国妇幼保健,2014,(29):1723-1725.
[14]赵怡莎,薛诚.性早熟女童阴道出血50例临床分析.中国性科学,2014,23(12):19-21.
[15]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.中国性科学,2014,23(11):44-46.
[16]Liu S,Liu Q,Cheng X,et al.Effects and safety of combination therapy with gonadotropin-releasing hormone analogue and growth hormone in girls with idiopathic central precocious puberty:A meta-analysis.Journal of Endocrinological Investigation,2016,39(10):1167-1178.
[17]Bertelloni S,Mu l D.Treatment of central precocious puberty by GnRH analogs:Long-term outcome in men.Asian J Androl,2011,10(4):525-534.
[18]Heger S,Sippell WG,Partsch CJ.Gonadotropin-releasing hormone ana-logue treatment for precocious puberty Twenty years of experience.Endocr Dev,2012,10(8):94-125.
[2]李筠,梁黎,孙莉颖,等.联合应用促性腺激素类似物和生长激素治疗女童初潮后特发性中枢性性早熟.中华儿科杂志,2011,23(436):54-56.
[3]杜敏联.对中枢性(真性)性早熟诊断和治疗的建议.中华儿科杂志,2012,42(5):478-479.
[4]朱顺叶,陈红珊,马华梅,等.蛋白同化类固醇激素对GnRHa治疗后中枢性性早熟患儿生长的影响.中国儿童保健杂志,2013,17(1):51-53.
[5]孙燕,崔朝晖.小于8岁性早熟女童阴道出血20例分析.中国儿童保健杂志,2013,21(8):65-68.
[6]马华梅,杜敏联.GnRHa联用rh GH治疗真性性早熟女孩的疗效评价.中华内分泌代谢杂志,2013,22(3):252-255.
[7]马华梅,杜敏联.特发性中枢性性早熟女孩血瘦素和胰岛素样生长因子1浓度测定的意义.中国实用儿科杂志,2012,16(7):417-419.
[8]顾威,沈卫星.玉米赤霉烯酮污染与儿童性早熟发病相关性研究进展.中华实用儿科临床杂志,2014,29(8):637-639.
[9]熊翔宇,杨玉.血浆Kisspeptin水平对女童中枢性性早熟的诊断及疗效评估的意义.中华实用儿科临床杂志,2014,29(8):612-615.
[10]冯海英,张蕾,周燕,等.曲普瑞林对特发性中枢性性早熟女童体质量指数及终身高的影响.中国基层医药,2014,21(7):979-981.
[11]章董萍,黄卫宇,赵奕.周围性性早熟36例临床分析.中国实用儿科杂志,2011,34(4):765-766.
[12]张琼,管玉涛,颜林志,等.幼女阴道流血103例分析.中国现代医生,2011,49(4):545-546.
[13]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因素分析.中国妇幼保健,2014,(29):1723-1725.
[14]赵怡莎,薛诚.性早熟女童阴道出血50例临床分析.中国性科学,2014,23(12):19-21.
[15]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.中国性科学,2014,23(11):44-46.
[16]Liu S,Liu Q,Cheng X,et al.Effects and safety of combination therapy with gonadotropin-releasing hormone analogue and growth hormone in girls with idiopathic central precocious puberty:A meta-analysis.Journal of Endocrinological Investigation,2016,39(10):1167-1178.
[17]Bertelloni S,Mu l D.Treatment of central precocious puberty by GnRH analogs:Long-term outcome in men.Asian J Androl,2011,10(4):525-534.
[18]Heger S,Sippell WG,Partsch CJ.Gonadotropin-releasing hormone ana-logue treatment for precocious puberty Twenty years of experience.Endocr Dev,2012,10(8):94-125.