儿童性早熟临床指标与性腺轴成熟相关性研究  

The correlation between clinical indicators of precocious puberty and gonadal axis maturation in children

作　　者：韩煊 陈俏容 余长华 祝惠 郑琦玮 张琴[2] 洪琦 马丽亚[4] 张蔚 HAN Xuan;CHEN Qiaorong;YU Changhua;ZHU Hui;ZHENG Qiwei;ZHANG Qin;HONG Qi;MA Liya;ZHANG Wei(Longhua Branch Hospital,Shenzhen People's Hospital,Guangdong Shenzhen 518020,China;Shenzhen Children's Hospital,Guangdong Shenzhen 510028,China;Shenzhen Hospital of Southern Medical University,Guangdong Shenzhen 518101,China;Shenzhen Bao′an District Maternal and Child Health Hospital,Guangdong Shenzhen 518100,China)

机构地区：[1]深圳市人民医院龙华分院,广东深圳518020 [2]深圳市儿童医院,广东深圳510028 [3]南方医科大学深圳医院,广东深圳518101 [4]深圳市宝安区妇幼保健院,广东深圳518100

出　　处：《中国妇幼健康研究》2024年第11期1-6,共6页Chinese Journal of Woman and Child Health Research

基　　金：深圳市科创委基础面上项目(2021年696号)。

摘　　要：目的探讨儿童性发育临床信息在判断性腺轴成熟方面的参考价值,并对建立在基层利用基础临床信息监测和管理儿童性早熟的模式进行探索。方法选取2014年9月1日至2017年3月1日在深圳市宝安区妇幼保健院生长发育科诊断为性早熟、青春期发育过早、生长潜能受损的5~14岁儿童60名作为临床观察对象。按照促性腺激素释放激素激发试验(GnRH激发试验)情况,将其分为阴性组(24例)与阳性组(36例),对两组儿童的病史、体征、检验、检查指标进行比较分析。结果在基本情况中,阴性组与阳性组的年龄、女童年龄比较,差异均有统计学意义(Z值分别为-2.45、-3.19,P<0.05);在查体情况中,阴性组与阳性组预测身高矮小的比例比较,差异有统计学意义(χ^(2)=5.40,P<0.05)。在血液检查情况中,阴性组与阳性组的IGF-1(Z=-2.32)、FSH(t=7.66)、LH(Z=-3.94)、T(Z=-2.99)及LH≥0.3IU/L(χ^(2)=5.94)的比例比较,差异均有统计学意义(P<0.05);在影像学检查情况中,阴性组与阳性组的骨龄(Z=-3.19)比较,差异有统计学意义(P<0.05)。结论基层医院可考虑根据儿童性发育基础临床信息对其发育状况进行性早熟风险评估管理。将疑似外周性性早熟的儿童转诊至上级医院,基层医院重点监测追踪骨龄、LH、IGF-1、FSH、T等指标,当患儿预测身高矮小、LH≥0.3IU/L时,需警惕儿童性轴成熟;对其综合评估后可考虑进行GnRH激发试验,以尽早确诊并及时干预性发育过早或过快对儿童造成的健康损害。Objective To explore the reference value of clinical information on children's sexual development in judging gonadal axis maturation,and to explore the model of using basic clinical information to monitor and manage children's precocious puberty at the grassroots level.Methods From September 1,2014 to March 1,2017,60 children aged 5-14 years who were diagnosed with precocious puberty and premature puberty in the Department of Growth and Development of Shenzhen Bao′an District Maternal and Child Health Hospital were selected as clinical observation subjects.According to the gonadotropin-releasing hormone provocation test(GnRH provocation test),the children were divided into negative group(24 cases)and positive group(36 cases),and the medical history,signs,examination and examination indexes of the two groups were compared and analyzed.Results In the basic situation,there were statistically significant differences in age between the gonadotropin stimulation test negative group and the positive group,as well as in the age of girls(Z values were-2.45,-3.19,P<0.05).In the physical examination,there were statistically significant differences in the proportion of predicted height short stature between the negative group and the positive group(χ^(2)=5.40,P<0.05).In the blood examination,the distribution of IGF-1(Z=-2.32),FSH(t=7.66),LH(Z=-3.94),T(Z=-2.99)and LH≥0.3IU/L(χ^(2)=5.94)between the negative group and the positive group were statistically significant(P<0.05).In the imaging examination,there was a statistically significant difference in bone age(Z=-3.19)between the negative group and the positive group(P<0.05).Conclusion Primary hospitals may consider risk assessment and management of precocious puberty based on the basic clinical information on children's sexual development.Children suspected of peripheral precocious puberty were referred to higher-level hospitals,and primary hospitals focused on monitoring and tracking bone age,LH,IGF-1,FSH,T and other indicators,and when children were predicted to be sho

关 键 词：性发育 性腺激素 促性腺激素释放激素激发试验 性早熟 健康管理 

分 类 号：R179[医药卫生—妇幼卫生保健]