超声检查在鉴别女童真假性性早熟中的应用

Application of ultrasonic examination in the identification of precocious and pseudoprecocious puberty in girls

目的探讨超声检查在女童真假性性早熟鉴别诊断中的作用。方法选择2012年7月至2015年7月在湖州市中心医院儿科就诊,并经骨龄测定及促性腺激素释放激素(GnRH)刺激试验确诊的真性性早熟女童35例、假性性早熟女童35例以及同年龄段35例正常女童进行盆腔超声检查,采集确诊的真性、假性性早熟女童以及对照组病例的子宫长径、前后径、横径,卵巢长径、前后径、横径、最大卵泡直径及一个切面>0.4cm的卵泡数目,并对测量结果处理分析。结果真性性早熟女童组的子宫各径线测量值和子宫容积与假性性早熟女童组比较均无显著性差异(t值分别为2.06、1.96、0.67、0.46,均P>0.05);真性性早熟女童组子宫各径线测量值和子宫容积均明显大于对照组(t值分别为15.06、9.07、9.27、15.42,均P<0.05);假性性早熟女童组子宫各径线测量值和子宫容积均明显大于对照组(t值分别为13.81、11.08、9.25、16.76,均P<0.05)。真性性早熟女童组的卵巢各径线测量值和卵巢容积均明显大于假性性早熟女童组(t值分别为17.47、5.61、12.30、18.53,均P<0.05);真性性早熟女童组的卵巢各径线测量值和卵巢容积均明显大于对照组(t值分别为14.06、13.42、14.11、20.83,均P<0.05),假性性早熟女童组卵巢横径测量值和卵巢容积与对照组比较均无显著性差异(t值分别为0.49、0.46,均P>0.05)。结论超声检查能客观地反映出女童性早熟的特征,间接反映促性腺素释放激素的分泌情况,能间接诊断和鉴别诊断女童真假性性早熟。

Objective To investigate the diagnostic role of ultrasonic examination in identification of precocious and pseudoprecocious puberty in girls. Methods Thirty-five cases of precocious puberty confirmed by bone age determination and Gonadotropin-releasing hormone（ GnRH）,35 cases of pseudoprecocious puberty and 35 normal girls diagnosed in department of pediatrics of Huzhou Central Hospital during the period of July 2012 to July 2015 were selected,and they underwent pelvic ultrasound examination to collect the data of uterine length,anterior and posterior diameter,transverse diameter,ovary length,anterior and posterior diameter,transverse diameter,maximum follicle diameter and the number of follicles in one section with a size over 0. 4cm. The measurement results were processed and analyzed.Results There were no significant differences in the diameters and uterine volume of uterus of true precocious group and pseudoprecocious group（ t value was 2. 06,1. 96,0. 67 and 0. 46,respectively,all P〉0. 05）. The diameters and volume of uterus of precocious group were significantly higher than those of the control group（ t value was 15. 06,9. 07,9. 27 and 15. 42,respectively,all P〈0. 05）,and those of pseudoprecocious group were also significantly higher than those of the control group（ t value was 13. 81,11. 08,9. 25 and 16. 76,respectively,all P〈0. 05）. The measured values of each ovarian diameter and ovarian volume were significantly higher in precocious group than in pseudoprecocious group（ t value was 17. 47,5. 61,12. 30 and 18. 53,respectively,all P〈0. 05）,and they were also significantly higher than in the control group（ t value was 14. 06,13. 42,14. 11 and 20. 83,respectively,all P〈0. 05）. The difference in measured value of transverse diameter and ovarian volume between the pseudoprecocious group and the control group was not significant（ t value was 0. 49 and 0. 46,respectively,both P〉0. 05）. Conclusion Ultrasonic examination can objectively reflect the characteristics of precocious and pseudoprecocious puberty and indirectly reflect the secretion of GnRH. It can indirectly diagnose and differentially diagnose precocious and pseudoprecocious puberty.