快速进展型中枢性性早熟女性儿童的 病情随访标志物分析

Follow-up analysis of disease markers in female children with rapidly progressive central precocious puberty

摘要:

目的 探究快速进展型中枢性性早熟（RP-CPP）女性儿童的病情随访标志物。方法 回顾性分 析2013 年6 月—2017 年6 月深圳市第六人民医院收治的108 例中枢性性早熟女性儿童的临床资料，所有患儿 均经6 个月无干预随访，其中66 例患儿为RP-CPP，42 例患儿为缓慢进展型中枢性性早熟（SP-CPP）。单因 素和Logistic 多因素分析RP-CPP 的相关因素，并比较经6 个月无干预随访后两组患儿病情相关指标变化程度。 结果 SP-CPP 组与RP-CPP 组患者的骨龄与实际发病年龄差值（BA-CA）、黄体生成素基值（LH）、卵泡 雌激素基值（FSH）、LH/FSH、胰岛素样生长因子Ⅰ标准差积分（IGF- Ⅰ SDS）、黄体生成素峰值/ 卵泡刺 激素峰值（LHP/FSHP）及最大卵泡直径（MFD）差异有统计学意义（P <0.05）。Logistic 多因素分析结果显示， 高LH 和高IGF- Ⅰ SDS 为RP-CPP 发生的危险因素（P <0.05）。两组患儿随访6 个月后，RP-CPP 组患儿 的身高、△ BA/ △ CA、黄体生成素（LH）及卵巢容积的前后差值均高于SP-CPP 组患儿，预测成年身高（PAH） 差值低于SP-CPP 组患儿，差异均有统计学意义（P <0.05）。结论 LH 高和IGF- Ⅰ SDS 高为RP-CPP 发生的 危险因素，可通过监测CPP 患儿的身高、△ BA/ △ CA、LH、PAH 和卵巢容积变化预测患儿病情进展。

Abstract:

Objective To investigate the follow-up markers of rapidly progressive central precocious puberty (RP-CPP) in female children. Methods The clinical data of 108 female children with precocious puberty in Shenzhen Sixth People’s Hospital from June 2013 to June 2017 were analyzed retrospectively. All children were followed up for 6 months without intervention. Among them, 66 cases had RP-CPP, 42 children had slow progressive central precocious puberty (SP-CPP). Univariate and multivariate logistic analyses were used to analyze the related factors of RP-CPP. The changes of disease-related indicators were compared between the two groups of children after 6 months without intervention. Results The difference between bone age and actual age of onset (BA-CA), base value of luteinizing hormone (LH), base value of follicular estrogen (FE), LH/FE, standard deviation integral of insulin-like growth factor I (IGF-I SDS), LH peak/follitropin peak, and maximal follicle diameter were different between the SP-CPP and RP-CPP patients (P < 0.05). High LH and high IGF-I SDS were the risk factors for RP-CPP (P < 0.05). After 6-month follow-up, the differences of height, breast stage, △ BA/ △ CA, LH and ovarian volume in the RP-CPP children were significantly greater than those in the SP-CPP children, the difference in the predicted adult height (PAH) in the RP-CPP children was smaller than that in the SP-CPP children (P < 0.05). Conclusions High LH and high IGF-I SDS are the risk factors for RP-CPP. The progression of the disease may be predicted by monitoring the changes of height, breast stage, △ BA/ △ CA, LH, PAH and ovarian volume in children with CPP.