昆明地区学龄前女童同性性早熟病因及临床特点分析  

Analysis of Pathogeny and Clinical Characteristics in Preschool Girls with Isosexual Precocious Puberty in Kunming

作　　者：张红红[1] 陶娜[1] 祁建勤[1] 熊晨璐[1] 杨洋[1] 

机构地区：[1]昆明医科大学附属儿童医院内分泌科,云南昆明650032

出　　处：《昆明医科大学学报》2015年第3期142-145,共4页Journal of Kunming Medical University

摘　　要：目的探讨昆明地区学龄前女童同性性早熟231例病因及临床特点.方法应用促性腺激素释放激素（Gn RH）激发实验测定黄体生成素（LH）,卵泡刺激素（FSH）,雌二醇（E2）水平,同时测定甲状腺功能、肝肾功能、对卵巢肿瘤者测定肿瘤标记物;盆腔B超、骨龄、垂体MRI.结果外周性性早熟152例（占65.8%）,明确病因诊断的82例,前3位为误服药品及滋补品60例（误服避孕药55例）,卵巢肿瘤20例,Mc Cune-Albright综合症2例,另有70例病因不明.部分性早熟57例（占24.7%）,其中单纯乳房发育53例、阴毛早发育4例.中枢性性早熟（central precocious puberty,CPP）22例（占9.5%）,其中特发性中枢性性早熟15例,垂体微腺瘤3例,下丘脑错构瘤2例,脑积水1例,甲状腺功能减退1例.长期随访1-3 a发现外周性性早熟（peripheral precocious puberty,PPP）有5例,部分性早熟有5例转化为中枢性性早熟.结论不同病因引起的性早熟有不同的特点,CPP以器质性病变为主占（7/22,30.82%）且性激素提高、骨龄提前最多.PPP以病因不明及误服避孕药最为常见.部分性性早熟转化为中枢性比例最高（5/57,8.77%）.因患儿年龄小,检查欠合作者,未行垂体MRI及盆腔B超检测,检查存在盲区,更需进行长期随访.Objective To explore the pathogeny and clinical features in 231 preschool girls with isosexual precocious pubertyin in Kunming. Methods Gonadotropin releasing hormone（Gn RH） stimulate experiments were applied to determine the luteinizing hormone（LH）,and follicle stimulating hormone（FSH）,estradiol（E2）level, thyroid function, the function of liver and kidney were also measured. The tumor markers, pelvic B ultrasound, bone age and pituitary MRI were determined in the girls with ovarian tumor. Results There were 152 cases with peripheral precocious puberty（PPP,65.8%）, and 82 of them could reach the definite etiological diagnosis.The causes of 60 cases were ingestion of drug and tonic accidentally（acyeterion in 55 cases）, 20 cases were ovarian tumor, 2 cases were Mc Cune-Albright syndrome,and etiology was unknown in 70 cases. 57 cases were part precocious puberty（24.7%）, including 53 cases with simple premature thelarche, 4 cases with premature pubarche. During 22 cases of central precocious puberty（CPP, 9.5%）,there were 15 patients with idiopathic central precocious puberty,3 cases with pituitary micro adenoma,2 cases with hypothalamic hamartoma,1 case with hydrocephalus, and 1 case with hypothyroidism. Long term follow-up of 1-3 years found that 5 cases were peripheral precocious puberty,and partial sexual precocity were transformed into central precocious puberty in5 cases. Conclusions Precocious puberty has different characteristics under different causes. Pathological change is the main cause of CPP（7/22,30.82%）, accompanied by elevation of sex hormone and advancement of bone age.PPP with unknown etiology and drug ingestion is the most common. Partial sexual precocity turned into centralprecocious puberty accounts for the highest proportion（5/57, 8.77%）. Because pituitary MRI and pelvic ultrasound are not applied in the younger children, they need long-term follow-up.

关 键 词：学龄前女童 同性性早熟 病因 特点 长期随访 

分 类 号：R725.8[医药卫生—儿科]