女童快速型中枢性性早熟早期预警及随访标志物的多中心研究
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摘要
目的对女童快速型中枢性性早熟的早期预警和随访标志物进行分析与探究。方法本次研究选取本院2014年6月-2017年1月期间在我院就诊的132新发的性早熟女童患者作为研究对象,根据发病特点分为快速进展型中枢性性早熟组和缓慢进展型性早熟组,对两组患者的相应的生理指标进行比较,同时对两组患者在随访过程中各指标的变化的幅度进行比较,对可能导致中枢性性早熟的快速进展指标进行发现和分析。结果快速进展组黄体峰值/卵泡峰值、黄体值、促卵泡激素值、胰岛素生长因子、体重指数分别为0.2±0.08、0.70±0.03 m IU/ml、3.87±0.01 m IU/ml、1.12±0.57 m IU/ml、28.72±1.83 kg/m2,缓慢进展组各相应指标分别为0.1±0.03、0.21±0.01m IU/ml、2.83±0.02 m IU/ml、0.45±0.05 m IU/ml、25.45±1.45 kg/m~2,两组与实际差值存在统计学差异(P<0.05);随访半年后对两组的相关指标进行观察发现身高、黄体值、促卵泡激素值、乳房分析体重指数变化和骨龄与实际差值两组对比存在显著的差异(P<0.05)。结论黄体峰值/卵泡峰值、黄体值、促卵泡激素值、胰岛素生长因子、体重指数和骨龄与实际差值指标可以作为快速进展型中枢性性早熟的早期预警提示指标。
Objective To analyze and explore the early warning and follow-up markers for rapid central precocious puberty in girls. Methods 132 cases of girls newly diagnosed with precocious puberty in our hospital from June,2014 to January,2017 were selected as the subjects. According to the morbidity characteristics,they were divided into rapidly progressive central precocious puberty group and slowly progressive precocious puberty group. The corresponding physiological indexes and the changes of indicators in the follow-up process of the two groups of patients were compared,and the indicators that might lead to rapidly progressive central precocious puberty were to be discovered and analyzed. Results The peak of corpus luteum/follicle,corpus luteum,follicle stimulating hormone,insulin growth factor and body mass index in the rapidly progressive group were respectively 0. 2 ± 0. 08,0. 70 + 0. 03 m IU/ml,3. 87 ± 0. 01 m IU/ml,1. 12 + 0. 57 m IU/ml and28. 72 ± 1. 83 kg/m2. The corresponding indexes in the slow progress group were respectively 0. 1 ± 0. 03,0. 21 ± 0. 01 m IU/ml,2. 83 ± 0. 02 m IU/ml,0. 45 ± 0. 05 m IU/ml,25. 45 ± 1. 45 kg/m2. And there was significant difference between the two groups( P < 0. 05). After six months of follow-up,observation of the related indexes of the two groups showed that there were significant differences in the changes of height,corpus luteum,follicle stimulating hormone,body mass index( BMI),and bone age and actual difference between the two groups( P < 0. 05). Conclusion The peak of corpus luteum/follicle,corpus luteum,follicle stimulating hormone,insulin growth factor,body mass index,bone age and actual difference indexes can be used as an early warning indicator for rapidly progressive central precocious puberty.
Objective To analyze and explore the early warning and follow-up markers for rapid central precocious puberty in girls. Methods 132 cases of girls newly diagnosed with precocious puberty in our hospital from June,2014 to January,2017 were selected as the subjects. According to the morbidity characteristics,they were divided into rapidly progressive central precocious puberty group and slowly progressive precocious puberty group. The corresponding physiological indexes and the changes of indicators in the follow-up process of the two groups of patients were compared,and the indicators that might lead to rapidly progressive central precocious puberty were to be discovered and analyzed. Results The peak of corpus luteum/follicle,corpus luteum,follicle stimulating hormone,insulin growth factor and body mass index in the rapidly progressive group were respectively 0. 2 ± 0. 08,0. 70 + 0. 03 m IU/ml,3. 87 ± 0. 01 m IU/ml,1. 12 + 0. 57 m IU/ml and28. 72 ± 1. 83 kg/m2. The corresponding indexes in the slow progress group were respectively 0. 1 ± 0. 03,0. 21 ± 0. 01 m IU/ml,2. 83 ± 0. 02 m IU/ml,0. 45 ± 0. 05 m IU/ml,25. 45 ± 1. 45 kg/m2. And there was significant difference between the two groups( P < 0. 05). After six months of follow-up,observation of the related indexes of the two groups showed that there were significant differences in the changes of height,corpus luteum,follicle stimulating hormone,body mass index( BMI),and bone age and actual difference between the two groups( P < 0. 05). Conclusion The peak of corpus luteum/follicle,corpus luteum,follicle stimulating hormone,insulin growth factor,body mass index,bone age and actual difference indexes can be used as an early warning indicator for rapidly progressive central precocious puberty.
引文
[1]孙曼青,陆文丽,王伟,等.女童快速进展型中枢性性早熟早期预警及随访标志物的多中心研究[J].中国内分泌代谢杂志,2017,33(4):312-314.
[2]张利.长效促性腺激素释放激素类似物对特发性中枢性性早熟的疗效观察[J].现代医院,2013,13(8):42-44.
[3]KIM J H,CHOI Y J,LIM H S,et al.Improvement offood habits and eating behavior of children with obesityand precocious puberty by nutrition education monitoring[J].J Korean Soc Food Cult,2015,30:129-36.
[4]SEO JW.Obesity in children and adolescents[J].Korean JPediatr,2009,52:1311-1320.
[5]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.
[6]许珊珊,顾学范,潘慧,等.儿童青少年血清胰岛素生长因子-1及胰岛素因子结合蛋白-3的正常参考值研究[J].临床儿科杂志,2009,27(12):1105-1110.
[7]SHIM K S,KIM J T.Therapy for idiopathic precocious puberty in children[J].Journal of the Korean Medical Association,2011,54(9):953.
[8]ZUNG A,BURUNDUKOV E,ULMAN M,et al.The diagnostic value of first voided urinary LH compared with GNRH stimulated gonadotropins in differentiating slowly progressive from rapidly progressive precocious puberty in girls[J].Eur J Endocrinol,2014,170(5):749-758.
[9]BURT SOLORZANO C M,MCCARTNEY C R.Obesity and the pubertaltransition in girls and boys[J].Reproduction,2010,140:399-410.
[10]CALCATERRA V,SAMPAOLO P,KLERSY C,et al.Utility of breast ultrasonography in the diagnostic work up of precocious puberty and proposal of a prognostic index for identifying girls with rapidly progressive central precocious puberty[J].Ultrasound Obstet Gynecol,2009,33(1):85-91.
[11]张倩茹.GnRHa治疗中枢性性早熟女孩糖脂代谢及性腺轴功能随访研究[D].福建医科大学,2016.
[12]赵渺凡.栀早颗粒对女童肝郁痰结型特发性中枢性性早熟GH和IGF-1的影响[D].黑龙江中医药大学,2013.
[13]张英华,颜美玲,张丹.中枢性性早熟幼女性激素、IGF-1与生长发育的临床关系探讨[J].中国医药导报,2017,14(35):75-78.
[14]侯秀刚.栀早颗粒对女童肝郁痰结型特发性中枢性性早熟BGP水平的影响[D].黑龙江中医药大学,2012.
[15]程美英.女童两种性早熟的影像学特点及性激素水平分析[D].郑州大学,2011.
[16]邱志文.特发性中枢性性早熟的辨证分型及与性激素水平的相关性研究[D].广州中医药大学,2007.
[2]张利.长效促性腺激素释放激素类似物对特发性中枢性性早熟的疗效观察[J].现代医院,2013,13(8):42-44.
[3]KIM J H,CHOI Y J,LIM H S,et al.Improvement offood habits and eating behavior of children with obesityand precocious puberty by nutrition education monitoring[J].J Korean Soc Food Cult,2015,30:129-36.
[4]SEO JW.Obesity in children and adolescents[J].Korean JPediatr,2009,52:1311-1320.
[5]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.
[6]许珊珊,顾学范,潘慧,等.儿童青少年血清胰岛素生长因子-1及胰岛素因子结合蛋白-3的正常参考值研究[J].临床儿科杂志,2009,27(12):1105-1110.
[7]SHIM K S,KIM J T.Therapy for idiopathic precocious puberty in children[J].Journal of the Korean Medical Association,2011,54(9):953.
[8]ZUNG A,BURUNDUKOV E,ULMAN M,et al.The diagnostic value of first voided urinary LH compared with GNRH stimulated gonadotropins in differentiating slowly progressive from rapidly progressive precocious puberty in girls[J].Eur J Endocrinol,2014,170(5):749-758.
[9]BURT SOLORZANO C M,MCCARTNEY C R.Obesity and the pubertaltransition in girls and boys[J].Reproduction,2010,140:399-410.
[10]CALCATERRA V,SAMPAOLO P,KLERSY C,et al.Utility of breast ultrasonography in the diagnostic work up of precocious puberty and proposal of a prognostic index for identifying girls with rapidly progressive central precocious puberty[J].Ultrasound Obstet Gynecol,2009,33(1):85-91.
[11]张倩茹.GnRHa治疗中枢性性早熟女孩糖脂代谢及性腺轴功能随访研究[D].福建医科大学,2016.
[12]赵渺凡.栀早颗粒对女童肝郁痰结型特发性中枢性性早熟GH和IGF-1的影响[D].黑龙江中医药大学,2013.
[13]张英华,颜美玲,张丹.中枢性性早熟幼女性激素、IGF-1与生长发育的临床关系探讨[J].中国医药导报,2017,14(35):75-78.
[14]侯秀刚.栀早颗粒对女童肝郁痰结型特发性中枢性性早熟BGP水平的影响[D].黑龙江中医药大学,2012.
[15]程美英.女童两种性早熟的影像学特点及性激素水平分析[D].郑州大学,2011.
[16]邱志文.特发性中枢性性早熟的辨证分型及与性激素水平的相关性研究[D].广州中医药大学,2007.