中枢性性早熟女性儿童指标检测及其危险因素分析

Indicators detection and risk factors analysis of female children with central precocious puberty

目的检测中枢性性早熟女性儿童各项指标,探讨影响性早熟的各相关危险因素。方法选取西安市儿童医院在2017年12月至2019年1月收治的120例女性中枢性性早熟患儿作为观察组,另随机选取同时期同龄的正常女性儿童120例作为对照组。分别对两组儿童进行性早熟各项指标检测[包括瘦素、促黄体生成素(LH)、血清卵泡刺激性素(FSH)、睾酮(T)、雌二醇(E2)、垂体催乳素(PRL)及血清骨钙素(BGP)、胰岛素样生长因子-1 (IGF-1)、胰岛素生长因子结合蛋白(IGFBP-3)],比较各项指标差异及两组儿童子宫容积、卵巢容积及卵泡数(直径>4 mm)情况。采用本院自制的问卷调查影响中枢性性成熟的相关危险因素。结果 240例儿童均完成研究;观察组和对照组儿童的身高[(129.56±12.76) cm vs (118.31±12.46) cm]、体质量[(30.78±7.76) kg vs (22.23±4.54) kg]、BMI [(24.27±2.38) kg/m2vs (21.35±2.23) kg/m2]、骨龄[(9.82±3.32)岁vs (7.73±2.24)岁]比较,观察组明显高于或重于对照组,差异均具有统计学意义(P<0.05);观察组和对照组儿童的LH [(3.31±3.88) mIU/mL vs (1.58±0.21) mIU/mL]、FSH [(4.76±3.01) mIU/mL vs (2.45±2.98) mIU/mL]、E2[(69.38±24.15) pg/mL vs (26.33±14.16) pg/mL]、PRL [(9.46±2.01) ng/mL vs(6.75±2.98) ng/mL]水平比较,观察组明显高于对照组,差异均具有统计学意义(P<0.05);观察组和对照组儿童的T水平[(0.90±0.44) ng/mL vs (1.21±0.52) ng/mL]比较,观察组明显低于对照组,血清瘦素[(7.88±3.15) ng/mL vs (3.83±2.16) ng/mL]、BGP [(23.38±18.23)μg/L vs (8.36±3.16)μg/L]、IGF-1 [(353.31±130.08)μg/L vs (207.58±38.25)μg/L]、IGFBP-3 [(5 332.46±960.67)μg/L vs (4 085.75±441.07)μg/L浓度比较,观察组明显高于对照组,差异均具有统计学意义(P<0.05);观察组患儿的子宫体积、卵巢体积明显大于对照组,直径>4 mm的卵泡数量明显多于对照组,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,母亲初潮年龄<13岁、父母兄弟姐妹具有性早熟、家庭父母关系不和睦、经常使用塑料制品、居住区域处于城市、居住区域具有污染性工厂、经常饮用饮料、经常运动、使用成年洗漱用品、喜爱情感类电视书籍等、偏食、经常食用动物性或高蛋白食品、经常食用洋快餐和服用营养滋补品均是中枢性性早熟的高度危险因素(P<0.05)。结论检测儿童的性激素指标可有效判定患儿早熟情况,了解儿童性成熟的相关危险因素有助于临床更好地预防和治疗性早熟现象。

Objective To detect the indicators of female precocious puberty and to explore the related risk factors of precocious puberty. Methods A total of 120 children with central precocious puberty were enrolled in Xi’an Children’s Hospital from December 2017 to January 2019. A total of 120 normal female children of the same age were randomly selected as the control group. The precocious puberty indicators were tested in both groups, including leptin,luteinizing hormone(LH), serum follicle stimulating hormone(FSH), testosterone(T), estradiol(E2), pituitary prolactin(PRL), and serum osteocalcin(BGP), insulin-like growth factor-1(IGF-1), insulin growth factor binding protein(IGFBP-3). The differences in various indicators and the uterine volume, ovarian volume, and follicles(diameter>4 mm)in the two groups were compared. The self-made questionnaire was used to investigate the risk factors affecting central sexual maturity. Results All 240 children completed the study. The height, body weight, body mass index(BMI), bone age in the observation group were significantly higher or heavier than those in the control group(P<0.05):(129.56 ±12.76) cm vs(118.31±12.46) cm,(30.78±7.76) kg vs(22.23±4.54) kg,(24.27±2.38) kg/m2 vs(21.35±2.23) kg/m2,(9.82±3.32) years vs(7.73±2.24) years. LH, FSH, E2, PRL in the observation group were significantly higher than those in the control group(P<0.05):(3.31±3.88) m IU/mL vs(1.58±0.21) m IU/mL,(4.76± 3.01) mIU/mL vs(2.45±2.98) mIU/mL,(69.38 ± 24.15) pg/mL vs(26.33 ± 14.16) pg/mL,(9.46 ± 2.01) ng/mL vs(6.75 ± 2.98) ng/mL. T level in the observation group was significantly lower than that in the control group(P<0.05):(0.90±0.44) ng/mL vs(1.21±0.52) ng/mL. Serum leptin, BGP, IGF-1, IGFBP-3 in the observation group were significantly higher than those in the control group(P<0.05):(7.88 ± 3.15) ng/mL vs(3.83 ± 2.16) ng/mL,(23.38 ± 18.23) μ g/L vs(8.36 ± 3.16) μ g/L,(353.31 ± 130.08) μ g/L vs(207.58±38.25) μg/L,(5 332.46±960.67) μg/L vs(4 085.75±441.07) μg/L. The uterine volume and ovarian volume in the observation group were significantly larger than those in the control group, and the number of follicles> 4 mm in diameter was significantly more than that in the control group(P<0.05). Multivariate Logistic regression analysis showed that the following were the high risk factors for central precocious puberty(P<0.05): the age of the women’s menarche <13 years, sexual precocity of the parents/brothers/sisters, unharmonious parental relationship, using plastic products frequently, living in the city, living area with polluting factories, drinking beverages frequently, regular exercise, use of adult toiletries, affectionate TV or books, partial eclipse, regular consumption of animal or high protein foods, found of snacks, and nutritious products. Conclusion Detecting children’s sex hormone indicators can effectively determine the precocity of children, and understanding the risk factors of children’s sexual maturity is helpful to prevent and treat precocious puberty better.