青春发动时相提前影响因素的系统评价

Relevant factors of early puberty timing: a systematic review

目的系统评价青春发动时相提前的影响因素。方法计算机检索VIP、CNKI、CBM、WanFangData、PubMed、Ovid、Web of Science、EBSCO和The Cochrane Library数据库,搜集从建库到2016年11月21日发表的青春发动时相提前影响因素的研究。由2名研究者独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用定量分析和定性分析相结合的方法进行系统评价。结果共纳入146个研究,以病例-对照研究为主(74个)。系统评价结果提示:青春发动时相提前的影响因素研究主要涉及10大类,包括肥胖、饮食偏好和营养摄入、环境内分泌干扰物、基因、社会心理应激、社会经济状态、生活方式、宫内生长发育、母亲初潮年龄、出生体重、孕期不良因素暴露。结论肥胖、环境内分泌干扰物、基因、宫内生长发育迟缓及母亲初潮年龄较早可能增加儿童青春发动时相提前的发生风险,其余影响因素的研究结果尚不十分确定。建议开展高质量的前瞻性队列研究和针对男童的研究,明确青春发动时相提前的定义及相关影响因素,收集定量数据进行相关性分析。

Objectives To systematicaUy review the status quo of studies on the influencing factors of early puberty timing.Methods We searched VIP,GNKI,CBM,WanFang Data,PubMed,Ovid,Web of Science,EBSCO and The Cochrane Library to collect studies on the influencing factors of early puberty timing published up to November 16th, 2016.Two reviewers independently screened.literature,extracted data and assessed the risk of bias of included studies. Then,quantitative analysis and qualitative synthesis methods were used to analyze the studies.Results A total of 146 studies were included,among which 74 were case-control studies.The results showed that:the influencing factors on early puberty timing mainly included 10 aspects:obesity,dietary preference and nutritional intake,environmental endocrine disruptors,genetic,social psychologycal stress,social economic status,lifestyle,intrauterine fetal growth,maternal age at menarche and weight,adverse factors during pregnancy.Conclusions The current systematic review showed that obesity,genetic,environmental endocrine disruptors,intrauterine fetal growth and early maternal age at menarche may increase the risk of early puberty timing,while other factors remain controversial.While the definition of early puberty timing and related factors have not been unified,most studies focus on females and qualitative data with lack of in-depth analysis.Therefore high quality cohort studies and studies on males are required.