女童快速进展型中枢性性早熟早期预警及随访标志物的多中心研究  

A multi.center clinical study of early predictors and follow-up parameters for girls with rapidly progressive central precocious puberty

作　　者：孙曼青[1] 陆文丽[1] 王伟[1] 顾学范[2] 叶军[2] 邱文娟[2] 黄晓东[3] 余永国[3] 吕拥芬[4] 李嫔[4] 

机构地区：[1]上海交通大学医学院附属瑞金医院儿内科,200025 [2]上海交通大学医学院附属新华医院小儿内分泌、遗传代谢室 [3]上海交通大学医学院附属儿童医学中心内分泌科 [4]上海交通大学附属儿童医院内分泌科

出　　处：《中华内分泌代谢杂志》2017年第4期312-316,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市科学技术委员会医学重点科研项目（12411950400）

摘　　要：目的探寻女童快速进展型中枢性性早熟（rapidlyprogressivecentralprecociouspube^y，RP．CPP）临床早期预警及随访标志物。方法采用多中心、非随机、前瞻性巢式病例对照的研究方法入组新发中枢性性早熟（centralprecociouspube^v，CPP）女童260例，选取其中114例无干预随访6个月者进行成组研究，70例纳入RP—CPP组、44例纳入缓慢进展型CPP组（slowlyprogressiveCPP，SP—CPP）。结果初诊时血清黄体生成素（LH）基值和胰岛素样生长因子I标准差积分（IGF—lSDS）是CPP快速进展的危险因素（0R值分别为4．04、1．578），且以LH基值危险性最大。受试者工作特征（ROC）曲线显示LH基值、IGF—ISDS的曲线下面积分别为0．83、0．807；LH基值和IGF—ISDS的切割值分别在0．52mIU／ml、0．35时对应约登指数最大。随访6个月后2组比较显示，RP—CPP组女童的身高、乳房分期、LH、子宫容积和卵巢容积随访前后差值以及骨龄变化量与实际年龄变化量的比值均显著大于SP—CPP组（均P〈O．05）。结论血清LH基值、IGF—ISDS可能是临床早期识别女童RP—CPP的预警标志，LH基值改变、性腺和性征发育进展速度、身高增长及生长潜能受损程度的变化可被视为随访CPP进展的关键指标。Objective To study the early diagnostic predictors and key follow-up parameters for girls with rapidly progressive central precocious puberty （ RP-CPP）. Methods A total of 260 girls with CPP participated in a prospective, nonrandomized, multi-center, nested case control study. After follow-up six months without any therapy, 114 girls were divided into RP-CPP （ n = 70） and slowly progressive CPP （SP-CPP） （ n = 44 ） groups. Results The basal serum LH and insulin-like growth factor I standard deviation score （ IGF- I SDS） were the important risk factors of RP-CPP （ OR 4.04, 1. 578 ）, especially the former. The receiver operating characteristic （ ROC ） curve revealed that the areas under the ROC curve of basal LH and IGF- [ SDS were 0.83 and 0. 807, respectively. The levels of basal LH and IGF- I SDS were at 0.52 mIU/ml and 0.35 respectively for the accuracy diagnosis of RP-CPP with the maximum Youden indexs. After follow-up for six months, the change levels of height, breast stages, bone age/ chronological age ratio, serum LH, uterine and ovarian volume in RP-CPP group were significantly higher than those in SP-CPP group （ all P〈0.05 ）. Conclusions The level of basal serum LH and IGF- [ SDS may be used as the risk predictors for early diagnosis for girls with RP-CPP. The change levels of basal LH, progress rates of gonad and sex character, height, and impaired growth potential seem to be the key follow-up parameters for CPP progress.

关 键 词：中枢性性早熟 预警标志 随访参数 

分 类 号：R725.8[医药卫生—儿科]