单纯乳房早发育和中枢性性早熟女童血清25羟维生素D水平的分析

Analysis of serum 25-hydroxy vitamin D level in girls with central precocious puberty and simple early breast development

目的分析单纯乳房早发育和中枢性性早熟女童血清25羟维生素D[25-(OH)D]水平的临床意义,为预防性早熟进展提供理论依据。方法选取2015年1月-2017年1月在本院专科门诊就诊的诊断为性早熟女童84例,其中根据诊断标准分为单纯乳房早发育组和中枢性性早熟组;根据国际维生素D营养状况的分类方法,将性早熟组女童分为维生素D正常组、不足组、缺乏组;另选取80例健康女童为对照组。记录并统计年龄、体重、身高、体重指数(BMI)、骨龄(BA);骨龄与生活年龄比值(BA/CA)、用化学发光免疫分析仪检测血清黄体生成素(LH)水平、卵泡刺激素(FSH)、促黄体生成素峰值(P-LH)、促卵泡雌激素峰值(P-FSH)、血清雌二醇(E2)水平,采用25-(OH)D水平评价维生素D水平。结果性早熟组女童血清25-(OH)D水平为(53.02±20.64)nmol/L,显著低于正常对照组女童[(74.32±14.30)nmol/L],且差异有统计学意义(t=-9.19,P<0.05);中枢性性早熟组女童25-(OH)D水平[(36.09±11.83)nmol/L]低于单纯乳房早发育女童[(55.29±23.08)nmol/L],差异有统计学意义(t=-3.357,P<0.05)。25-(OH)D不足组与25-(OH)D缺乏组骨龄(BA)、实际年龄(CA)、BMI-SDS、身高SDS、体重SDS、LH、FSH基础值、E2、P-LH、P-FSH等差异均无统计学意义(P>0.05);25-(OH)D不足组P-LH[(30.31±13.45)U/L]和P-FSH[(22.66±7.70)U/L]与25-(OH)D正常组P-LH[(10.67±9.34)U/L]和P-FSH[(17.12±9.23)U/L])比较差异有统计学意义(t=3.603、3.127,P<0.05);25-(OH)D缺乏组P-LH[(32.39±14.56)U/L)]和P-FSH[(25.09±10.56) U/L]与25-(OH)D正常组P-LH和P-FSH差异有统计学意义(t=4.825、5.242,P<0.05)。结论性早熟女童维生素D水平减低,且维生素D水平与性早熟的发生及进程可能相关。

Objective To investigate the clinical significance of serum 25-hydroxy vitamin D[25-(OH)D]level in girls with precocious puberty and simple early breast development.Methods A total of 84 girls diagnosed with precocious puberty and treated in Hainan Province Maternity&Child Health Care Hospital from January 2015 to January 2017 were enrolled in this study,and were divided into simple early development group and central precocious puberty group according to the diagnostic criteria.According to the international vitamin D nutritional status classification methods,the precocious puberty girls were divided into normal level of vitamin D group,deficiency group and insufficiency group and another 80 healthy girls were selected as control group.The general information including age,body weight,height,body mass index(BMI),bone age(BA)and the ratio of bone age to chronological age(BA/CA)were recorded.And serum levels of luteinizing hormone(LH),follicle stimulating hormone(FSH),luteinizing hormone peak(P-LH),follicle stimulating hormone peak(P-FSH),serum estradiol(E2)were tested and analyzed.The level of vitamin D was assessed by serum level of 25-(OH)D.Results The level of serum 25-(OH)D in precocious puberty group was(53.02±20.64)nmol/L,which was significantly lower than that in control group[(74.32±14.30)nmol/L](t=-9.19,P<0.05).Likewise,serum 25-(OH)D level in central precocious puberty group was significantly lower than that in simple early breast development group((36.09±11.83)nmol/L vs.(55.29±23.08)nmol/L,t=-3.357,P<0.05)There were no significant differences on BA,CA,BMI,height,weight,and the levels of LH,FSH,E2,P-LH,P-FSH between 25-(OH)D deficiency group and insufficiency group(P>0.05).There were significant differences on the levels of P-LH and P-FSH between 25-(OH)D insufficiency group and normal level of 25-(OH)D group(P-LH:(30.31±13.45)U/L vs.(10.67±9.34)U/L,P-FSH:(22.66±7.70)U/L vs.(17.12±9.23)U/L,t=3.603,3.127,P<0.05)Meanwhile,there were significant differences on the levels of P-LH[(32.39±14.56)U/L]and P-FSH[(25.09±10.56)U/L]between 25-(OH)D deficiency group and normal level of 25-(OH)D group(t=4.825,5.242,P<0.05).Conclusion Vitamin D level in precocious puberty girls is decreasing,and it may be related to the development and progress of precocious puberty.