青春期男性乳房发育与生长速率关系研究

Corretation study of gynecomastia and peak height velocity for males at puberty

目的研究136例患儿乳房发育发生率、骨龄、生长速率、睾丸容积以及血清中胰岛素样生长因子（IGF-1）、雌二醇／睾酮含量等，探讨青春期男性乳房发育与生长速率的关系及其可能机制。方法回顾性研究2008年3月至2009年3月因矮小等原因在郑州大学第三附属医院儿童内分泌诊治中心就诊的136例男孩，年龄8～11（9．4±1．1）岁，睾丸容积≤3ml，无第二性征发育，每3个月测定身高，观察生长速率、睾丸容积及乳房发育情况；每半年应用TW3方法评定骨龄。结果①136例患儿最大生长速率（PHV）年龄为（14．6±0．9）岁，骨龄为（12．9±0．9）岁，其中发现有青春期男性乳房发育52例（38．2％），乳房开始发育年龄为（14．2±1．2）岁，骨龄为（12．9±0．6）岁，睾丸容积为（9．6±1．8）ml；乳房开始发育年龄与PHV有显著相关性（r=0．902，P〈0．05）。②血清中IGF-1含量在相同骨龄的乳房开始发育组较乳房未发育组稍增高，但差异未见统计学意义（P〉0．05），而雌二醇／睾酮含量在乳房开始发育组较乳房未发育组明显增高，且差异有统计学意义（P〈0．05）。结论部分男性患儿可能在生长速率最大时出现青春期男性乳房发育，其机制可能与雌二醇／睾酮含量增高有关。

Objective To describe the characteristics for males at puberty in order to elucidate the corretation between pubertal gynecomastia and peak height velocity（PHV）. Methods Data about physical growth and sexual development of 136 males at age 8 to 11 years were obtained from pediat- ric endocrinology center from March 2008 to March 2009 in the third affiliated hospital of Zhengzhou university. General characteristics of height velocity, bone age, insulin-like growth factor-1 （ IGF-1 ） and serum estrogen/serum testosterone were compared and analyze based on different ages, respec- tively. Results （1）When 52 gynecomastia were first observed in the 136 boys in （ 14.2 ±1.2） years old, the bone age was （ 12.9 ± 0.6） years and testicular volume was （9.6 ±1.8 ） ml. Their mean age at PHV was （ 14.6 ± 0.9 ） years old. PHV was strongly correlated with the age at which gynecomastia was first observed （ r = 0. 902, P 〈 0.05 ）. （2）Serum estrogen/serum testosterone level was significantly higher in gynecomastia group than that in none gynecomastia group （ P 〈 0.05 ）. Conclusions Part of the boys may have gynecomastia during the peak height velocity of growth, its mechanism maybe related to the elevation of levels of estrogen/testosterone.