儿童性早熟192例临床分析

Clinical analysis on 192 children with precocious puberty

目的:探讨儿童性早熟的年龄、病因及临床特征,提高对本病的认识。方法:对2007年4月～2010年5月在九江市妇幼保健院诊治的192例(男5例,女187例)性早熟儿童的年龄、临床特征、病因、实验室数据进行回顾性分析。结果:儿童性早熟中以女性为主,占97.4%,年龄以8月～1岁占2.08%,～3岁占28.12%,～9岁7月占69.79%。临床表现最常见的是乳房增大占92.9%,其次为乳房色素沉着占65.5%,外阴分泌物增多占12.3%,阴毛早现占4.3%和阴蒂(阴茎)、睾丸增大占4.6%,阴道出血占0.01%。病因:促性腺素依赖性性早熟(CPP)占26.4%,同性性早熟中女性除垂体肿瘤2例、先天性甲状腺功能减低症1例、Williams综合征1例外,余均为特发性性早熟,男性先天性肾上腺皮质增生症2例。非促性腺素依赖性性早熟(GIPP)占73.6%。女性均表现为同性性早熟,男性则因外源性摄入雌激素(避孕药)表现为异性性早熟3例。<3岁的婴幼儿发病率达28.12%,除1例CAH及1例垂体肿瘤外,均为GIPP,发病人群以农村儿童多见占87%,尤以留守儿童为主,以酸奶饮料代替牛奶,不加节制的喝饮料和吃油炸小零食以及误服避孕药是发病的主要原因。结论:儿童性早熟病因复杂,须仔细询问病史、体格检查,及相应的实验室检查。特别关注农村婴幼儿饮食安全,提高家长认知能力,应引起社会的关注。

Objective： To explore the age, causes, and clinical characteristics of precocious puberty, elevate cognition of children with precocious puberty. Methods： The age, clinical characteristics, causes, laboratory data of 192 children （including 5 boys and 187 girls） with precocious puberty who were diagnosed and treated in the hospital from April 2007 to May 2010 were analyzed retrospectively. Results： The proportion of girls among the children with precocious puberty was 97.4% ; the percentages of children aged $ months -one year, -3 years, -9 years accounted for 2. 08% , 28. 12% , and 69. 79%, respectively. The most common clinical manifesta- tion was breast hyperplasia, accounting for 92.9%, followed by breast pigmentation （65.5%）, increase of vulval secretion （ 12. 3% ）, pre- mature pubarche （for 4. 3% ）, augmentation of clitoris （ cauda salax） and didymus （4. 6% ）, and vaginal bleeding （0. 01% ） . Causes： the children with gonadotropic hormone dependent precocious puberty accounted for 26. 4%. Among the girls with isosexual precocious pu- berty, except two girls with pituitary neoplasms, one girl with congenital hypothyroidism （CH） , and one girl with Williams syndrome, other girls were diagnosed as idiopathic precocious puberty. Two boys were diagnosed as congenital adrenal cortical hyperplasia （CAH） . The children with non - gonadotropic hormone dependent precocious puberty accounted for 73.6%. All the girls manifested as isosexual preco-cious puberty ; 3 boys manifested as heterosexual precocious puberty because of intake of exogenous estrogen （contraceptives） . The preva- lence of precocious puberty among the infants less than three years was 28.12%. Except one child with CAH and one child with pituitary ne- oplasms, other children were diagnosed as non - gonadotropic hormone dependent precocious puberty ; among the children with precocious puberty, rural children accounted for 87% , stay - at -home children accounted for most of the children, the main causes included drinking yogurt - drinks instead of milk, drinking beverage without control, eating fried food and snacks, and taking wrong contraceptives. Conclusion： The causes of precocious puberty are complex, it is necessary to ask medical histo^2~ carefully, conduct physical examination and corresponding laboratory examination. Dietary safety of rural infants should be paid more attention to, the cognitive ability of parents should be improved, and the disease needs attention from the society.