223例性早熟女童病因分析及临床研究

Etiological and clinical research of 223 girls with precocious puberty

目的探讨性早熟女童的病因与年龄的关系,关注6~8岁年龄组生长速率、骨龄与发病的关系。方法收集2015年1月至2017年12月在中山市博爱医院内分泌门诊及病房诊治的223例性早熟女童的临床资料,回顾性分析患儿的一般临床资料、发病原因,并对所得数据行统计学分析。结果性早熟最常见的是特发性GnRH依赖型(44%)、单纯性乳房早发育(38%)。在<3岁组中最常见的是单纯性乳房早发育(68%),3~<6岁患儿中主要为继发性GnRH依赖型(42%),6~8岁患儿中最常见的为特发性GnRH依赖型(56%),单纯性乳房早发育(32%)。GnRH依赖型生长速度(8.9±2.3cm/年,n=89)高于单纯性乳房早发育者(7.2±1.2cm/年,n=55)(t=3.494,P<0.001),骨龄提前(2.0±0.9年)较单纯性乳房早发育(1.3±1.1年)明显(t=3.151,P=0.002)。结论女童性早熟原因很多,婴幼儿主要为单纯性乳房早发育,学龄前儿童继发性GnRH依赖型多见,6~8岁女童主要是特发性GnRH依赖型,生长速率、骨龄亦或作为6~8岁组特发性GnRH依赖型、单纯性乳房早发育的简易鉴别指标。

Objective To explore the relationship between the etiology and age of girls with precocious puberty and focus on the relationship between growth rate, bone age and etiology of group of aged 6-8 years. Methods The clinical data of 223 girls with precocious puberty selected from outpatient department and ward of endocrinology in Boai Hospital of Zhongshan City were retrospectively analyzed, and the general clinical data and causes of the children were analyzed for statistical analysis. Results Idiopathic GnRH dependence （44%） and premature thelarche （PT） （38%） were most common. In girls under 3 years old PT was most common （68%）, secondary GnRH dependence was most common in children aged 3 6 years old （42%）, idiopathic GnRH dependence （56%） and PT （32%） were most common in children aged 6 - 8 years old. Growth rate of children of GnRH dependence（8.9±2.3cm/year, n= 89） was higher than that of children withPT （7.2±1.2cm/year, n=55） （t=3.494,P〈 0.001）, and the early development of bone age of children of GnRH dependence （2.0±0.9 years） was more significant than that of children of PT （ 1.3 ± 1.1 years） （ t = 3.151, P = 0.002）. Conclusion There are various causes of precocious puberty in girls, PT is most common in infants, secondary GnRH dependence is common in preschoolers, and in girls aged 6 8 years idiopathic GnRH dependence is the main type. Growth rate and bone age may be as a convenient distinguishing indicator for diagnosis of idiopathic GnRH dependence and PT for group of aged 6-8.