兒童性早熟臨床指標與性腺軸成熟相關(guān)性研究

［摘要］目的探討兒童性發(fā)育臨床信息在判斷性腺軸成熟方面的參考價值，并對建立在基層利用基礎(chǔ)臨床信息監(jiān)測和管理兒童性早熟的模式進行探索。方法選取2014年9月1日至2017年3月1日在深圳市寶安區(qū)婦幼保健院生長發(fā)育科診斷為性早熟、青春期發(fā)育過早、生長潛能受損的5～14歲兒童60名作為臨床觀察對象。按照促性腺激素釋放激素激發(fā)試驗（GnRH激發(fā)試驗）情況，將其分為陰性組（24例）與陽性組（36例），對兩組兒童的病史、體征、檢驗、檢查指標進行比較分析。結(jié)果在基本情況中，陰性組與陽性組的年齡、女童年齡比較，差異均有統(tǒng)計學(xué)意義（Z值分別為-2.45、-3.19，P＜0.05）；在查體情況中，陰性組與陽性組預(yù)測身高矮小的比例比較，差異有統(tǒng)計學(xué)意義（χ2=5.40，P＜0.05）。在血液檢查情況中，陰性組與陽性組的IGF-1（Z=-2.32）、FSH（t=7.66）、LH（Z=-3.94）、T（Z=-2.99）及LH≥0.3IU/L（χ2=5.94）的比例比較，差異均有統(tǒng)計學(xué)意義（P＜0.05）；在影像學(xué)檢查情況中，陰性組與陽性組的骨齡（Z=-3.19）比較，差異有統(tǒng)計學(xué)意義（P＜0.05）。結(jié)論基層醫(yī)院可考慮根據(jù)兒童性發(fā)育基礎(chǔ)臨床信息對其發(fā)育狀況進行性早熟風(fēng)險評估管理。將疑似外周性性早熟的兒童轉(zhuǎn)診至上級醫(yī)院，基層醫(yī)院重點監(jiān)測追蹤骨齡、LH、IGF-1、FSH、T等指標，當患兒預(yù)測身高矮小、LH≥0.3IU/L時，需警惕兒童性軸成熟；對其綜合評估后可考慮進行GnRH激發(fā)試驗，以盡早確診并及時干預(yù)性發(fā)育過早或過快對兒童造成的健康損害。

［關(guān)鍵詞］性發(fā)育；性腺激素；促性腺激素釋放激素激發(fā)試驗；性早熟；健康管理

Doi：10.3969/j.issn.1673-5293.2024.11.001

［中圖分類號］R179［文獻標識碼］A［文章編號］1673-5293（2024）11-0001-06The correlation between clinical indicators of precocious puberty and gonadal axis maturation in children

HAN Xuan CHEN Qiaorong YU Changhua ZHU Hui ZHENG Qiwei ZHANG Qin HONG Qi MA Liya ZHANG Wei

（1.Longhua Branch Hospital，Shenzhen People's Hospital，Guangdong Shenzhen 518020，China;2.Shenzhen Children's

Hospital，Guangdong Shenzhen 510028，China;3.Shenzhen Hospital of Southern Medical University，Guangdong Shenzhen

518101，China;4.Shenzhen Bao′an District Maternal and Child Health Hospital，Guangdong Shenzhen 518100，China）［Abstract］ 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 （χ²=5.40，P＜0.05）.In the blood examination，the distribution of IGF-1 （Z=-2.32），F(xiàn)SH （t=7.66），LH （Z=-3.94），T （Z=-2.99） and LH≥0.3IU/L （χ²=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，F(xiàn)SH，T and other indicators，and when children were predicted to be short in height and LH≥0.3IU/L，they should be vigilant against children's sexual axis maturation;after a comprehensive evaluation，a GnRH provocation test can be considered to diagnose early and intervene in a timely manner the health damage caused by premature or rapid sexual development.

［Key words］ sexual development;gonadal hormones;gonadotropin-releasing hormone provocation test;precocious puberty;health management隨著社會經(jīng)濟的發(fā)展，兒童性發(fā)育年齡提前已經(jīng)成為全球普遍的現(xiàn)象，性發(fā)育提前帶來的兒童健康問題也成為人們關(guān)注的熱點。……