北京市通州区2704名6~18岁女童青春期性征发育现状

Current status of pubertal sexual characteristics development of 2704 girls aged 6-18 years in Tongzhou District of Beijing

目的了解北京市通州区6~18岁女童青春期性发育现状,并比较消瘦、正常体重、超重及肥胖女童性发育情况的差异。方法2022年9月至2023年7月对北京市通州区2844名6~18岁女童进行横断面调查,现场测查乳房、阴毛发育分期,询问月经初潮状况,测量体重和身高,并划分为消瘦组、正常体重组和超重及肥胖组。问卷调查获得家庭及个人基本信息。应用Probit概率单位回归方法计算性征发育各期年龄、月经初潮年龄,计数资料组间比较采用χ^(2)检验。结果共调查2844名女童,符合纳入条件2704名,调查有效率为95.1%,其中6~9岁1105名(40.9%)、10~13岁1053名(38.9%)、14~18岁546名(20.2%)。女童身高Z分值(HAZ)、体重Z分值(WAZ)、体质指数Z分值(BAZ)分别为0.46(-0.23,1.16)、0.69(-0.16,1.67)、0.67(-0.27,1.73);消瘦、超重、肥胖检出率分别为1.7%(45/2704)、17.3%(467/2704)、19.9%(538/2704)。消瘦组45名、正常体重组1654名、超重及肥胖组1005名。乳房发育2期(B2)、阴毛发育2期(P2)、月经初潮年龄分别为9.0(95%CI 8.9~9.1)岁、10.5(95%CI 10.4~10.6)岁、11.4(95%CI 11.3~11.5)岁。发育期女童64.6%(1211/1874)乳房发育分期大于阴毛,32.4%(607/1874)乳房和阴毛发育分期相同,3.0%(56/1874)阴毛发育分期大于乳房。乳房发育B2与B5年龄差4.7(95%CI 4.6~4.8)年;阴毛发育P2与P5年龄差4.5(95%CI 4.4~4.6)年;B2与月经初潮年龄差2.4(95%CI 2.3~2.5)年。消瘦、正常体重、超重及肥胖组B2年龄依次为10.0(95%CI 9.5~10.6)、9.3(95%CI 9.2~9.4)、8.6(95%CI 8.4~8.7)岁,月经初潮年龄依次为13.1(95%CI 12.4~13.7)、11.6(95%CI 11.4~11.7)、11.1(95%CI 11.0~11.2)岁;超重及肥胖组女童B2与B5年龄间隔、P2与P5年龄间隔为4.5、4.1年,正常体重组分别为4.7、4.5年,消瘦组分别为4.6、4.7年。结论北京市通州区女童性征发育各期年龄以及初潮年龄较20年前北京市报道有提前趋势;超重肥胖女童相比于正常体重女童不仅青春期开始发育年龄更早,而且发育进程也有缩短。

Objective To understand the current status of pubertal sexual characteristics development of girls aged 6-18 years in Tongzhou District of Beijing and to compare the differences in sexual characteristics development among girls characterized as thin,normal,overweight,and obese.Methods A cross-sectional survey was conducted among 2844 girls aged 6-18 years in Tongzhou District of Beijing from September 2022 to July 2023.The developmental stages of breast and pubic hair were assessed on site,and menarche status was inquired.Weight and height were measured.The girls were subsequently characterized into thin,normal,overweight and obese groups.Basic information(including family and personal history)was obtained through questionnaires.Probit probability unit regression was applied to calculate the age of each Tanner stage of sexual characteristics development and the age of menarche.Theχ^(2)test was applied to compare the counting data between two or multiple groups.Results A total of 2844 girls were surveyed and 2704 girls met the inclusion criteria,resulting in a valid response rate of 95.1%.Among these girls,1105(40.9%)were aged 6-9 years,1053(38.9%)were aged 10-13 years,and 546(20.2%)were aged 14-18 years.The of height-for-age Z-score(HAZ),weight-for-age Z-score(WAZ),and body mass index-for-age Z-score(BAZ)were 0.46(-0.23,1.16),0.69(-0.16,1.67),and 0.67(-0.27,1.73)respectively.The prevalences of thin,overweight,and obesity were respectively 1.7%(45/2704),17.3%(467/2704),and 19.9%(538/2704),respectively.There were 45 girls in the thin group,1654 girls in the normal weight group,1005 girls in the overweight and obesity group.The age of Tanner stage breast 2(B2),Tanner stage pubic hair 2(P2),and menarche was 9.0(95%CI 8.9-9.1),10.5(95%CI 10.4-10.6),and 11.4(95%CI 11.3-1.5)years,respectively.The current status of breast and pubic hair maturity in girls with pubertal development shows that 64.6%(1211/1874)of these girls had breast development preceding pubic hair development,32.4%(607/1874)had concurrent breast and pubic hair development,and 3.0%(56/1874)had pubic hairs development preceding breast development.The interval age between B2 and B5 was 4.7(95%CI 4.6-4.8)years,between P2 and P5 was 4.5(95%CI 4.4-4.6)years,and between B2 and menarche was 2.4(95%CI 2.3-2.5)years.The ages of sexual characteristics development in overweight and obese groups were earlier than that in normal and thin groups.The ages of B2 in thin,normal,overweight,and obese groups were 10.0(95%CI 9.5-10.6),9.3(95%CI 9.2-9.4),and 8.6(95%CI 8.4-8.7)years,respectively.The age of menarche in thin,normal,overweight,and obese groups were 13.1(95%CI 12.4-13.7),11.6(95%CI 11.4-11.7),and 11.1(95%CI 11.0-11.2)years,respectively.The interval ages between B2 and B5 and between P2 and P5 was 4.5 and 4.1 years,respectively in the overweight and obese groups,and those in normal group and thin group was 4.7 and 4.5 years,4.6 and 4.7 years,respectively.Conclusions The ages of sexual characteristics development and menarche tend in Tongzhou District of Beijing to be earlier than that being reported of Beijing's survey 20 years ago.Girls characterized as overweight and obese not only start puberty at an earlier age than girls of normal weight,but also have a shorter developmental process.