家庭因素与儿童青春发动时相关系的前瞻性队列研究

Prospective cohort study on the association between family factors and the puberty timing in children

目的探索不同家庭因素与儿童青春发动时相的关系,为进一步开展儿童青春期发育研究提供参考。方法采用目的性抽样方法,对重庆市九龙坡区1237名儿童进行为期5年的前瞻性队列随访,采用Cox回归分析家庭因素与儿童青春发动时相的关系。结果单因素分析结果显示,基线年龄和体质量指数(BMI)是男女童青春发动时相提前的影响因素(P值均<0.01);顺产相较于剖宫产的女童更早观察到乳房发育(HR=1.27,95%CI=1.04~1.54);自觉家庭经济条件好是女童月经初潮(HR=0.81,95%CI=0.66~0.99)、阴毛发育(HR=0.80,95%CI=0.65~0.97)和男童青春发动时相提前(睾丸发育HR=0.69,95%CI=0.58~0.83;首次遗精HR=0.62,95%CI=0.49~0.78;外生殖器发育HR=0.70,95%CI=0.56~0.87;阴毛发育HR=0.66,95%CI=0.54~0.80)的保护因素;留守男童更晚观察到睾丸发育(HR=0.74,95%CI=0.57~0.96)、首次遗精(HR=0.71,95%CI=0.50~0.99)、阴毛发育(HR=0.68,95%CI=0.51~0.91);自觉父母关系好的男童更早观察到睾丸发育(HR=1.26,95%CI=1.01~1.58)(P值均<0.05)。多因素分析结果显示,流动女童阴毛发育的时间更晚(HR=0.79,95%CI=0.65~0.96),家庭因素与男童青春发动时相无关。结论是否留守、自觉父母关系、自觉家庭经济条件是儿童青春发动时相的影响因素,但在调整年龄和BMI等因素后,这种联系主要体现在女童阴毛青春发育指标上,对于家庭因素与其他青春发育事件的关系仍需要进一步随访调查加以证实。

Objective To explore the association between different family factors and children’s puberty timing,and to provide a reference for further research on puberty development of children. Methods A prospective cohort study was conducted on a total of 1 237 children in one district,Chongqing,using targeted sampling. Cox regression was used to analyze the association between family factors and the puberty timing of children. Results The results of univariate analysis showed that baseline age and BMI were risk factors of early puberty timing in boys and girls( P<0.01). Breast development( HR = 1.27,95%CI = 1.04-1.54)was observed earlier in vaginal delivery than in cesarean section. Self-conscious family economic condition is good is the protective factor for the early timing of girl’s menstruation( HR = 0.81,95%CI = 0.66-0.99),pubic hair development( HR = 0.80,95%CI =0.65-0.97) and the boy’s puberty development( Testicular development HR = 0.69,95% CI = 0.58-0.83,first ejaculation HR =0.62,95% CI = 0.49-0.78,external genitalia development HR = 0.70,95% CI = 0.56-0.87,pubic hair development HR = 0.66,95%CI = 0.54-0.80). The left-behind boys later observed testicular development( HR = 0.74,95%CI = 0.57-0.96),first ejaculation( HR = 0.71,95% CI = 0.50-0.99) and pubic hair development( HR = 0.68,95% CI = 0. 51-0. 91). Testicular development( HR= 1.26,95%CI= 1.01-1.58) was observed earlier in boys who felt their parents were close( P<0.05). The results of multivariate analysis showed that the timing of pubic hair development was later in floating girls( HR = 0.79,95% CI = 0.65-0.96),and family factors had nothing to do with the puberty timing in boys. Conclusion In the study,left behind children,self-perceived of parents relationship and family economic conditions are the influencing factors of children’s puberty timing. However,after adjusted for age and BMI,this association was mainly found in pubic hair of girls. The association between family factors and other pubertal development events still needs to be confirmed by further follow-up investigation.