儿童性早熟临床指标与性腺轴成熟相关性研究

The correlation between clinical indicators of precocious puberty and gonadal axis maturation in children

摘要

目的 探讨儿童性发育临床信息在判断性腺轴成熟方面的参考价值,并对建立在基层利用基础临床信息监测和管理儿童性早熟的模式进行探索。方法 选取2014年9月1日至2017年3月1日在深圳市宝安区妇幼保健院生长发育科诊断为性早熟、青春期发育过早、生长潜能受损的5~14岁儿童60名作为临床观察对象.按照促性腺激素释放激素激发试验(GnRH激发试验)情况,将其分为阴性组(24例)与阳性组(36例),对两组儿童的病史、体征、检验、检查指标进行比较分析。结果 在基本情况中,阴性组与阳性组的年龄、女童年龄比较,差异均有统计学意义(Z值分别为-2.45、-3.19,P<0.05);在查体情况中,阴性组与阳性组预测身高矮小的比例比较,差异有统计学意义(χ²=5.40,P<0.05).在血液检查情况中,阴性组与阳性组的IGF-1(Z=-2.32)、FSH(t=7.66)、LH(Z=-3.94)、T(Z=-2.99)及LH≥0.3IU/L(χ²=5.94)的比例比较,差异均有统计学意义(P<0.05);在影像学检查情况中,阴性组与阳性组的骨龄(Z=-3.19)比较,差异有统计学意义(P<0.05)。结论 基层医院可考虑根据儿童性发育基础临床信息对其发育状况进行性早熟风险评估管理.将疑似外周性性早熟的儿童转诊至上级医院,基层医院重点监测追踪骨龄、LH、IGF-1、FSH、T等指标,当患儿预测身高矮小、LH≥0.3IU/L时,需警惕儿童性轴成熟;对其综合评估后可考虑进行GnRH激发试验,以尽早确诊并及时干预性发育过早或过快对儿童造成的健康损害.

Abstract

Objective To explore the reference value of clinical information on children's sexual development in judging gonadal axis maturation, and to explore the model of using basic clinical information to monitor and manage children's precocious puberty at the grassroots level. Methods From September 1, 2014 to March 1, 2017, 60 children aged 5-14 years who were diagnosed with precocious puberty and premature puberty in the Department of Growth and Development of Shenzhen Bao'an District Maternal and Child Health Hospital were selected as clinical observation subjects. According to the gonadotropin-releasing hormone provocation test (GnRH provocation test), the children were divided into negative group (24 cases) and positive group (36 cases), and the medical history, signs, examination and examination indexes of the two groups were compared and analyzed. Results In the basic situation, there were statistically significant differences in age between the gonadotropin stimulation test negative group and the positive group, as well as in the age of girls (Z values were -2.45, -3.19, P<0.05). In the physical examination, there were statistically significant differences in the proportion of predicted height short stature between the negative group and the positive group (χ²=5.40, P<0.05). In the blood examination, the distribution of IGF-1 (Z=-2.32), FSH (t=7.66), LH (Z=-3.94), T (Z=-2.99) and LH≥0.3IU/L (χ²=5.94) between the negative group and the positive group were statistically significant (P<0.05). In the imaging examination, there was a statistically significant difference in bone age (Z=-3.19) between the negative group and the positive group (P<0.05). Conclusion Primary hospitals may consider risk assessment and management of precocious puberty based on the basic clinical information on children's sexual development. Children suspected of peripheral precocious puberty were referred to higher-level hospitals, and primary hospitals focused on monitoring and tracking bone age, LH, IGF-1, FSH, T and other indicators, and when children were predicted to be short in height and LH≥0.3IU/L, they should be vigilant against children's sexual axis maturation; after a comprehensive evaluation, a GnRH provocation test can be considered to diagnose early and intervene in a timely manner the health damage caused by premature or rapid sexual development.

关键词

性发育 / 性腺激素 / 促性腺激素释放激素激发试验 / 性早熟 / 健康管理

Key words

sexual development / gonadal hormones / gonadotropin-releasing hormone provocation test / precocious puberty / health management

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基金资助

深圳市科创委基础面上项目(2021年696号)