789例儿童乳房早发育病因及临床特点分析

Analysis of clinical characteristics of children premature thelarche

目的：分析儿童乳房发育的临床特点。方法详细询问789例以乳房发育为主诉的患儿第二性征出现的时间、生长速率及外源性激素接触情况，分析其乳房发育的病因及临床特点。比较≥7岁患儿GnRH依赖组及非GnRH依赖组的子宫、卵巢、卵泡及LH基础值的差异。结果不同年龄儿童病因分别为：0～3岁患儿中，主要乳房早发育（93．72％）、误服避孕药（4．6％）；4～6岁患儿中主要乳房早发育（80．56％）、部分性性早熟（8．33％）、中枢性性早熟（5．56％）；≥7岁患儿中乳房早发育（58．87％）、中枢性性早熟（13．79％）、正常乳房发育（22．91％）。 GnRH依赖组与非GnRH依赖组的子宫、卵巢及卵泡大小、LH基础值差异有统计学意义（P＜0．05），但两者子宫均值均小于3．5 cm，卵巢容积均大于1 ml，卵泡均小于4 mm。结论不同年龄组患儿乳房发育的病因不同，除单纯乳房早发育外，婴幼儿以接触外源性激素如误服避孕药较多，而中枢性性早熟主要集中在学龄前及学龄期的儿童，特别是学龄期。了解不同年龄组病因不同为临床医生的诊断思路提供了参考。

Objective To analyze the clinical feature of children premature thelarche .Methods The appearing time of sec-ondary sexual characteristics ,growth rate and exogenous hormone contact in 789 children who had premature thelarche were carefully questioned .The causes of premature thelarche and clinical feature were analyzed .The differences in uterine length ,ovarian volumes ,fol-licle and LH basic value between GnRH-dependent and non-GnRH-dependent children older than 7 years old were compared .Results In the 0～3 years old group ,93.72%of the children had premature thelarche and 4.6%accidently swallowed contraceptive pills .In the 4～6 years old group ,80.56%of the children had premature thelarche ,8.33%showed partial sexual precocity and 5.56%had central sexual precocity.In the≥7 years old group,58.87%of the children had premature thelarche ,13.79%had central sexual precocity and 22.91% presented normal mammary development .There were significant differences in uterine length ,ovarian volumes ,follicle and bas-al LH between the GnRH-dependent and the GnRH-non dependent groups （ P＜0.05 ） .However ,the uterine length was less than 3.5 cm,ovarian volume larger than l ml and follicle less than 4 mm in the both groups .Conclusion The main causes of premature the-larche were various in different age groups .The accident swallow of contraceptive pills and exposure to exogenous hormones are major causes in addition to simple premature thelarche .Central sexual precocity is concentrated in pre-school and school-age children.It is important for doctors to analyze the causes in different age children who have premature thelarche .