深圳地区儿童性发育及影响因素现况调查

Investigation on children sexual development and influencing factors in Shenzhen

目的了解深圳地区儿童性发育现状,以体格生长与性发育的关系制定筛查儿童性早熟倾向的方案和指标,以减少矮身材的发生率。方法将2014年9月1日至2017年3月1日于深圳市宝安区妇幼保健院生长发育科健康体检的807名1～16岁的儿童,按照是否有性腺发育分为性腺未发育组和性腺发育组,比较两组儿童性激素水平、甲状腺激素水平、骨龄、垂体大小各指标的差异,应用Logistic回归分析筛选出性腺发育的保护因素。结果①性腺发育组男童平均年龄为(8.23±2.66)岁,女童平均年龄为(8.34±1.93)岁。②性腺发育组儿童骨龄别矮身材、早产儿的比率较高(χ~2值分别为7.15、32.08,均P<0.05);年龄别矮身材、小于胎龄儿的比率较低(χ~2值分别为100.26、5.22,均P<0.05)。③性腺发育组儿童的骨龄、出生身长、出生体质量、儿童身高、儿童体质量、父亲身高、母亲身高、胰岛素样生长因子-1、17羟孕酮、卵泡刺激激素、黄体生成激素、雌二醇、睾酮、垂体宽径均高于性腺未发育组(t/Z=-13.63～-2.04,均P<0.05),而预测身高、促甲状腺激素均较性腺未发育组儿童低(t/Z值分别为5.83、2.44,均P<0.05)。④性发育的保护因素为母亲矮身材(B=-0.593,P<0.05),危险因素为胎龄分组(B=2.329,P<0.001)、体型(B=0.993,P<0.001)。结论深圳地区儿童有性发育提前的趋势。对早产儿、营养不良儿童应注意控制体质量追赶速度,避免过度追赶;控制儿童期肥胖,定期体格检查,监测骨龄,早期发现和干预性腺发育提前,预防儿童期身高生长受损和成年后慢性疾病的发生。

Objective To understand the status of children sexual development in Shenzhen and to reduce the incidence of short stature by developing screening program based on physical growth and sexual development. Methods Totally 807 children aged 1 to 16 years, receiving physical examination in Shenzhen Bao’an District Maternal and Child Health Hospital from September 1, 2014 to March 1, 2017, were divided into gonad developed group and the gonad undeveloped group. Two groups of children were compared in terms of levels of sex hormone, thyroid hormone, bone age and pituitary size, and Logistic regression analysis was used to screen the protective factors of gonad development. Results In the gonad developed group, the average age of boys was 8.23±2.66 years, and the average age of girls was 8.34±1.93 years. The rate of short stature to bone age and the rate of premature birth in the gonad developed group were higher(χ~2 value was 7.15 and 32.08, respectively, both P<0.05), but the rate of short stature to age and the rate of small for gestational age were lower(χ~2 value was 100.26 and 5.22, respectively, both P<0.05). The bone age, birth length, birth BMI, height, BMI, father’s height, mother’s height, insulin-like growth factor-1, 17-hydroxyprogesterone, follicle stimulating hormone, luteinizing hormone, estuarial, testosterone, wide of pituitary were higher in gonad developed group(t/Z value ranged-13.63--2.04, all P<0.05), but predicted height and TSH were lower(t/Z value was 5.83 and 2.44, respectively, both P<0.05). The protective factors of gonad development was short stature of mother, and the risk factors were gestational age grouping(B=2.329,P<0.001) and body size(B=0.993,P<0.001).Conclusion There is a trend of early sexual development of children in Shenzhen. For premature infants and malnourished children, attention should be paid to controll the speed of weight catching up and avoid excessive catching up. Childhood obesity control, regular physical examination, bone age monitoring, early detection and early intervention of gonad development are necessary to prevent childhood height growth impairment and adult chronic disease.