2020,20(94):161-162.
林泽太,吴东亮,潘全冠.研究高胆红素血症(高胆)新生儿血清S -100蛋白水平和总胆红素(TBC)与白蛋白(B/A)比值的变化情况[J].世界最新医学信息文摘(连续型电子期刊),2020,20(94):161-162.
[12]Chen XB,Zhang XM,Chen QN,et al.Prognostic evaluation value of
serum S -100B protein combined with NSE level for neonatal hypox-ic-ischemic encephalopathy [J].International Journal of Laboratory Medicine,2020,41(10):1175-1178.
陈小冰,张雪梅,陈求凝,等.血清S -100B 蛋白联合NSE 水平对新生儿缺氧缺血性脑病的预后评估价值[J].国际检验医学杂志,2020,41(10):1175-1178.
[13]Sun YH.Correlation study of serum glial fibrous acidic protein,insu-lin-like growth factor,and neonatal hypoxic-ischemic encephalopa-thy [J].Clinical Education of General Practice,2019,17(2):27-29.
孙颖慧.血清胶质纤维酸性蛋白、胰岛素样生长因子与新生儿缺氧缺血性脑病的相关性研究[J].全科医学临床与教育,2019,17(2):27-29.
[14]Wu RY ,Lin ZL.Clinical significance of serum insulin-like growth
factor -1in birth weight
and jaundice in preterm infants [J].Jour-nal of Mathematical Medicine,2019,32(9):1272-1274.
吴若雅,林振浪.血清胰岛素样生长因子-1在早产儿出生体重及黄疸中的临床意义[J].数理医药学杂志,2019,32(9):1272-1274.[15]He CX,Zhang H,Lu ZC.The clinical effect and adverse reaction ef-fect of children with neonatal jaundice [J].Chongqing Medicine,2019,1(A01):305-307.
何春霞,张恒,吕卓超.不同蓝光照射方式新生儿黄疸患儿的临床效果及不良反应发生率影响观察[J].重庆医学,2019,1(A01):305-307.
(收稿日期:
婴儿陈倩倩
2022-04-07)
中枢性性早熟及外周性性早熟女童的LH 、
LHRH 水平变化及临床意义
钟剑,魏苗苗,陈书远
惠州市第一人民医院儿科,广东惠州
516000
【摘要】目的
研究中枢性性早熟及外周性性早熟女童的黄体生成素(LH)、黄体生成素释放激素(LHRH)水
平变化及临床意义。方法回顾性分析2018年1月至2021年12月在惠州市第一人民医院儿科诊治的54例性早熟女童的临床资料,按照早熟性质分为中枢性组(中枢性性早熟,35例)与外周性组(外周性性早熟,19例)。采用化学发光免疫法检测所有女童的LH 、睾酮(T)、雌二醇(E2)、卵泡刺激素(FSH)水平及LHRH 激发试验中的LH 、FSH 水平,计算并比较两组女童的骨龄指数、子宫容积和卵巢容积。结果
中枢性组女童的LH 、FSH 水平分别为(4.35±
1.54)IU/L 、(7.28±
2.11)IU/L ,明显高于外周性组的(2.34±1.03)IU/L 、(4.60±1.32)IU/L ,T 水平为(12.41±19.22)μg/L ,明显低于外周性组的(84.46±12
3.24)μg/L ,差异均有统计学意义(P <0.05);中枢性组女童的E2水平为(16.73±23.60)ng/L ,与外周性组的(32.24±42.24)ng/L 比较差异无统计学意义(P >0.05);LHRH 激发试验分别30min 、60min 、90min ,中枢性组女童的LH 水平分别为(19.53±2.66)IU/L 、(16.15±2.12)IU/L 、(12.45±1.86)IU/L ,均明显高于外周性组的(5.65±1.78)IU/L 、(5.38±1.40)IU/L 、(
4.26±1.17)IU/L ,差异均有统计学意义(P <0.05);LHRH 激发试验分别30min 、60min 、90min ,中枢
性组女童的FSH 水平分别为(1
5.24±5.28)IU/L 、(15.90±5.06)IU/L 、(15.99±5.40)IU/L ,均明显高于外周性组的(10.96±3.27)IU/L 、(11.23±3.74)IU/L 、(10.12±3.21)IU/L ,差异均有统计学意义(P <0.05);两组女童的BAI 、子宫容积和卵巢容积比较差异均无统计学意义(P >0.05)。结论中枢性性早熟女童的LH 、LHRH 水平明显高于外周性性早熟女童,能够通过LH 、LHRH 水平对两者进行区分。
【关键词】中枢性性早熟;外周性性早熟;黄体生成素;黄体生成素释放激素;临床意义【中图分类号】R729
【文献标识码】A
【文章编号】1003—6350(2023)03—0364—04
Changes and clinical significance of LH and LHRH levels in girls with central precocious puberty and those with peripheral precocious puberty.ZHONG Jian,WEI Miao-miao,CHEN Shu-yuan.Department of Pediatrics,Huizhou First People's Hospital,Huizhou 516000,Guangdong,CHINA
【Abstract 】Objective To study the changes of luteinizing hormone (LH)and luteinizing hormone releasing hormone (LHRH)levels and their clinical significance in girls with central precocious puberty
and those with peripheral precocious puberty.Methods
The clinical data of 54precocious girls treated in Department of Pediatrics,Huizhou
First People's Hospital from January 2018to December 2021were retrospectively analyzed.According to the precocious nature,they were divided into central precocious group (central precocious,35cases)and peripheral precocious group (peripheral precocious,19cases).The levels of LH,testosterone (T),estradiol (E2),follicle stimulating hormone (FSH),and LH and FSH in LHRH stimulation test were detected by chemiluminescence immunoassay,and the bone age index,
·论著·
doi:10.3969/j.issn.1003-6350.2023.03.015
通讯作者:钟剑(1987—),男,副主任医师,主要研究方向为儿科疾病,E-mail:********************。
性早熟属于青春发育不正常的一种疾病,临床特征为与同龄儿童比较,青春期特征明显提前[1]。通常,男童于9周岁之前、女童于8周岁之前表现出性特征,或者是女童于10周岁之前月经来潮,就能诊断为性早熟[2]。依据病理控制机制的不同,将性早熟划分为中枢性性早熟及外周性性早熟,两者手段及预后截然不同,因此,准确、及时的诊断十分重要[3-4]。基于此,本文将研究中枢性性早熟及外周性性早
熟女童的黄体生成素(LH)、黄体生成素释放激素(LHRH)水平的变化及临床意义,现报道如下:
1资料与方法
1.1一般资料回顾性分析2018年1月至2021年12月在惠州市第一人民医院儿科诊治的54例性早熟女童的临床资料。纳入标准:(1)依据中华医学会儿科学分会(内分泌遗传代谢学)公布的诊断性早熟的相关标准[5]相符;(2)临床资料完整。排除标准:(1)伴有恶性肿瘤;(2)合并其他内分泌疾病;(3)先天性甲状腺功能减低引发的性早熟。按照早熟性质分为中枢性组(中枢性性早熟,35例)与外周性组(外周性性早熟,19例)。中枢性组女童病程7d~8个月,平均(3.64±1.52)个月;初诊年龄6~8岁,平均(7.04±0.95)岁;单或双侧乳房发育24例、月经来潮2例、阴道分泌物增加9例。外周性组女童病程8d~9个月,平均(3.43±1.65)个月;初诊年龄6~8岁,平均(7.12±0.78)岁;单或双侧乳房发育13例、月经来潮1例、阴道分泌物增加5例。两组女童的基线资料比较差异均无统计学意义(P>0.05)。本研究经医院医学伦理委员会批准,女童家属均知情并签署同意书。
1.2观察指标与检测方法(1)比较两组女童的LH、睾酮(T)、雌二醇(E2)、卵泡刺激素(FSH)水平及LHRH激发试验分别30min、60min、90min时的LH、FSH水平。全部女童于上午8~9h皮下注射醋酸曲普瑞林注射液(长春金赛药业有限公司生产;0.1mg:1mL;国药准字H20044922;15~30s注射完),用量
2.5μg/kg,最多100μg,将针头留置于前臂,同时确保血管通畅。在注射前与注射后30min、60min、90
min分别采集2mL 静脉血,保存于常温环境中,待检。LH、T、E2、FSH 水平及LHRH激发试验[6]中的LH、FSH水平使用化学发光免疫法检测,严格按照说明书操作。LH峰值超过5IU/L或LH/FSH大于0.6诊断为中枢性性早熟,否则为外周性性早熟。(2)比较两组女童的骨龄指数(BAI)、子宫容积和卵巢容积[7]。全部女童摄左手腕正位片,选择Greulich-Pyle图谱法检测骨龄,BAI=骨龄/年龄。子宫容积与卵巢容积:选择飞利浦超声诊断仪EPIQ7检测,女童憋尿后,保持仰卧位,探头(频率设置为7.5MHz)经体表腹部测量女童子宫厚度、宽径、长径、宫颈长度、子宫内膜厚度及双侧卵巢厚度、宽径、长径,并对一个切面最大卵泡直径进行测量。卵巢容积、子宫容积依据椭圆公式计算,卵巢容积=(长×宽×厚)/2,子宫容积=(长×宽×厚)/2。
1.3统计学方法应用SPSS20.0统计软件进行数据分析。计量资料以均数±标准差(x
-±s)表示,组间比较采用t检验,计数资料比较采用χ2检验。以P<0.05为差异有统计学意义。
2结果
2.1两组女童的LH、T、E2、FSH水平比较中枢性组女童的LH、FSH水平明显高于外周性组,T 水平明显低于外周性组,差异均有统计学意义(P< 0.05);而两组女童的E2比较差异无统计学意义(P> 0.05),见表1。
表1两组女童的LH、T、E2、FSH水平比较(x
-±s)
Table1Comparison of LH,T,E2and FSH levels between the two groups of girls(x-±s)
组别
中枢性组
外周性组
t值
P值
例数
35
19
LH(IU/L)
4.35±1.54
2.34±1.03
5.717
0.001
T(μg/L)
12.41±19.22
84.46±123.24
2.532
0.020
E2(ng/L)
16.73±23.60
32.24±42.24
1.480
0.152
FSH(IU/L)
7.28±2.11
4.60±1.32
5.728
0.001
uterine volume and ovarian volume were calculated and compared.Results The LH and FSH levels of children in the central precocious group were(4.35±1.54)IU/L and(7.28±2.11)IU/L,which were significantly higher than(2.34±1.03) IU/L and(4.60±1.32)IU/L in the peripheral precocious group,T level was(12.41±19.22)μg/L,significantly lower than (84.46±123.24)μg/L in the peripheral precocious group(
P<0.05).The E2level of the children in the central precocious group was(16.73±23.60)ng/L,versus(32.24±42.24)ng/L in the peripheral precocious group,and the difference was not statistically significant(P>0.05).At30minutes,60minutes,and90minutes of the LHRH stimulation test,the LH levels of children in the central precocious group were(19.53±2.66)IU/L,(16.15±2.12)IU/L,and(12.45±1.86)IU/L,which were significantly higher than(5.65±1.78)IU/L,(5.38±1.40)IU/L,(4.26±1.17)IU/L in the peripheral precocious group (P<0.05).At30minutes,60minutes,and90minutes of the LHRH stimulation test,the FSH levels of children in the central precocious group were(15.24±5.28)IU/L,(15.90±5.06)IU/L,and(15.99±5.40)IU/L,which were significantly higher than (10.96±3.27)IU/L,(11.23±3.74)IU/L,(10.12±3.21)IU/L in the peripheral precocious group(P<0.05).There were no sig-nificant difference in BAI,uterine volume,and ovarian volume between the two groups(P>0.05).Conclusion The lev-els of LH and LHRH in children with central precocious puberty were significantly higher than those in peripheral preco-cious puberty,which could be differentiated by LH and LHRH levels.
【Key words】Central precocious puberty;Peripheral precocious puberty;Luteinizing hormone;Luteinizing hor-mone releasing hormone;Clinical significance
表2两组女童LHRH激发试验中的LH、FSH水平比较(x
-±s)
Table2Comparison of LH and FSH levels in LHRH stimulation test between the two groups(x-±s)
组别
中枢性组外周性组t值
P值例数
35
19
30min
19.53±2.66
5.65±1.78
22.852
0.001
60min
16.15±2.12a
5.38±1.40
22.381
0.001
90min
12.45±1.86ab
4.26±1.17ab
19.812
0.001
30min
15.24±5.28
10.96±3.27
3.671
0.001
60min
15.90±5.06
11.23±3.74
3.855
0.001
90min
15.99±5.40
10.12±3.21
5.005
0.001
LH(IU/L)FSH(IU/L)
注:与本组30min比较,a P<0.05;与本组60min比较,b P<0.05。
Note:Compared with30min in this group,a P<0.05;Compared with60min in this group,b P<0.05.
2.3两组女童的BAI、子宫容积和卵巢容积比较两组女童的BAI、子宫容积和卵巢容积比较差异均无统计学意义(P>0.05),见表3。
3讨论
中枢性性早熟儿童的下丘脑-垂体-性腺轴已经运转,这类性早熟儿童发育顺序同正常青春期儿童类似,可提前引发生育功能[8]。除此之外,还会使骨骼生长加快、骨龄提前,导致患儿未成年时期比正常儿童高,然而成年后低于正常人,所以大部分患儿需使用促性腺激素释放激素类似物实施[9]。但是,外周性性早熟儿童的下丘脑-垂体-性腺轴尚未成熟,由于机体自身分泌或外源性摄入性激素引起异性或同性性早熟特征,因尚未具备生育功能,通常不进行干预[10-11]。中枢性与外周性性早熟的干预及转归并不相同,因此,及时、准确的诊断十分重要。
现在,性早熟的常用检查手段包括性激素、LHRH 刺激试验、超声检测及骨龄等[12]。性激素会刺激女童乳头,使部分乳腺发育及乳晕增大,而性早熟女童体内性激素水平都有程度不同的提升。所以,性激素监测对区分性早熟类型的意义不大[13]。本次研究显示,两组女童E2水平均较高,且差异不明显。骨龄提前能够证实激素水平较高。本研究显示,两组女童的骨龄都表现出提前症状,然而一部分外周性性早熟女童的骨龄也会提前,如肾上腺皮质增生症。但是早期中枢性性早熟女童的骨龄提前并不明显,所以骨龄在诊断方面并无特异性[14]。早期中枢性性早熟女童,性激素可不升高,子宫及卵巢的增大与外周性性早熟比较并无明显差异。而且,外周性性早熟在卵巢器质性或功能性自分泌、外源性性激素作用下也会增加子宫、卵巢容积[15]。加之,盆腔B超的操作者不同也会导致结果产生差异。所以,子宫、卵巢也不能成为诊断性早熟的主要依据。
LHRH是主要由下丘脑产生的一种多肽激素,可刺激已发育成熟垂体前叶,促使其分泌LH、FSH[6]。青
春期之前,LH、FSH分泌已经表现出昼夜节律,且夜间比较高,青春期早期,LH水平仅在夜间增加;青春中晚期,LH水平白天及夜间均会增加[16]。青春期与青春期之前,外源性LHRH反应就具有差异性,青春期之前主要是FSH水平提升,青春期主要是LH水平提升。外源性的LHRH注射后,中枢性性早熟女童由于已启动丘脑-垂体-性腺轴,主要是LH水平提升。但是,外周性性早熟女童由于未启动下丘脑-垂体-性腺轴,所以反应较弱或没有反应,或者主要是FSH提升[17]。本研究结果显示,LHRH刺激试验后分别30min、60min、90min后,LH、FSH水平明显高于未开始LHRH刺激试验时,其中,中枢性性早熟女童的LH、FSH水平明显高于外周性性早熟女童。因此针对性早熟女童,由于性激素表现为脉冲式分泌,所以LHRH刺激试验能成为中枢性性早熟及外周性性早熟的重要指标。
综上所述,中枢性性早熟女童的LH、LHRH水平明显高于外周性性早熟女童,能够通过LH、LHRH水平对二者进行区分。
参考文献
[1]Yang H,Luo SQ,Tang F,et al.Quality of life and its influencing fac-
tors in children with precocious puberty[J].China Nursing Manage-ment,2020,20(12):1795-1800.
杨红,罗顺清,唐芳,等.性早熟儿童生活质量及其影响因素研究[J].中国护理管理,2020,20(12):1795-1800.
[2]Yeh SN,Ting WH,Huang CY,et al.Diagnostic evaluation of central
precocious puberty in girls[J].Pediatr Neonatol,2021,62(2): 187-194.
[3]Dai LF,Tian H,Yang QY,et al.Epidemiological characteristics and
related factors of precocious puberty in children[J].Chinese Journal of Public Health Management,2017,33(1):136-137,140.
表3两组女童的BAI、子宫容积和卵巢容积比较(x
-±s) Table3Comparison of BAI,uterine volume and ovarian volume between the two groups(x-±s)
组别
中枢性组外周性组t值
P值例数
35
19
BAI
1.15±0.10
1.05±0.11
0.392
0.700
子宫容积(mL)
2.17±1.18
1.64±0.78
1.978
0.054
左侧
1.71±1.48
1.16±0.58
1.941
0.058
右侧
1.63±1.25
1.20±0.71
1.612
0.113
卵巢容积(mL)
2.2两组女童LHRH激发试验中的LH、FSH水平比较LHRH激发试验分别30min、60min、90min,中枢性组女童的LH、FSH水平明显高于外周性组,差异均有统计学意义(P<0.05),见表2。
戴丽凤,田华,杨燕,等.儿童性早熟流行病学特征及相关影响因素分析[J].中国公共卫生管理,2017,33(1):136-137,140.
[4]Yang T,Wang MH.Investigation and analysis of children's preco-
cious puberty and its influencing factors[J].China Maternal and Child Health Care,2016,31(7):1510-1512.
杨挺,王明欢.儿童性早熟与影响因素的调查分析[J].中国妇幼保健,2016,31(7):1510-1512.
[5]The Subspecialty Group of Endocrinologic,Hereditary and Metabolic
Diseases,The Society of Pediatrics,Chinese Medical Association;
The Editorial Board,Chinese Journal of Pediatrics,LIANG Y.Sum-mary of the conference of endocrinologic,hereditary and metabolic diseases of the Society of Pediatrics,Chinese Medical Association [J].Chin J Pediatrics,2008,46(6):22-25.
中华医学会儿科学分会内分泌遗传代谢学组,《中华儿科杂志》编辑委员会,梁雁.第九届全国儿科内分泌遗传代谢病学术会议纪要[J].中华儿科学杂志,2008,46(6):22-25.
[6]Yang LL.Diagnostic value of LHRH stimulation test for GnRHa in
girls with precocious puberty[J].Genomics and Applied Biology, 2016,35(11):2961-2965.
杨绿绿.LHRH激发试验LH峰值对性早熟女童GnRHa疗效的诊断价值[J].基因组学与应用生物学,2016,35(11):2961-2965. [7]Liu LM,Wang Q,Li YH.A multi-center study on early warning and
follow-up markers of rapid central precocious puberty in girls[J].
Modern Hospital,2018,18(7):1013-1015.
刘利梅,王强,李艳红.女童快速型中枢性性早熟早期预警及随访标志物的多中心研究[J].现代医院,2018,18(7):1013-1015. [8]Lee HK,Choi SH,Fan D,et al.Evaluation of characteristics of the
craniofacial complex and dental maturity in girls with central preco-cious puberty[J].Angle Orthod,2018,88(5):582-589.
[9]Aguirre RS,Eugster EA.Central precocious puberty:From genetics
to treatment[J].Best Pract Res Clin Endocrinol Metab,2018,32(4): 343-354.
[10]Lin S,Yang WQ,Y u J.Clinical diagnosis and treatment guideline of
pediatrics of traditional Chinese medicine·Precocious puberty(revi-sion)[J].Journal of Pediatrics of Traditional Chinese Medicine, 2016,12(3):1-5.
林甦,杨文庆,俞建.中医儿科临床诊疗指南·性早熟(修订)[J].中医儿科杂志,2016,12(3):1-5.
[11]Osman HA,Al-jurayyan NAM,Babiker AMI,et al.Precocious puber-
ty:An experience from a major teaching hospital in Central Saudi Arabia[J].Sudan J Paediatr,2017,17(1):19-24.[12]Hu SJ.Evaluation of uterine and ovarian ultrasound combined with
serum sex hormone levels in girls with precocious puberty[J].Chi-nese Journal of Experimental Diagnostics,2020,24(6):949-952.
胡胜娟.子宫、卵巢超声联合血清性激素水平评估女童性早熟的价值观察[J].中国实验诊断学,2020,24(6):949-952.
[13]Wang CY.Changes and correlation analysis of leptin and sex hor-
mone levels in children with precocious puberty[J].Chinese Journal of Maternal and Child Health,2017,32(11):2382-2384.
王彩云.性早熟儿童体内瘦素与性激素水平的变化及其相关性分析[J].中国妇幼保健,2017,32(11):2382-2384.
[14]Gao Y,Wang M,Song XY,et al.Clinical efficacy and safety of go-
nadotropin-releasing hormone analogue combined with recombinant human growth hormone in the treatment of height in girls with idio-pathic central precocious puberty[J].China Maternal and Child Health Care,2019,34(5):1062-1064.
高宇,王淼,宋小宇,等.促性腺激素释放激素类似物联合重组人生长激素特发性中枢性性早熟女童身高的临床疗效及安全性[J].中国妇幼保健,2019,34(5):1062-1064.
[15]Wang J,Luo H,Pang HQ,et al.Ultrasound measurement of uterus
and ovary from children to adolescence and the diagnostic value of ultrasound in precocious puberty[J].Journal of Sichuan University (Medical Science),2019,50(4):583-587.
王晋,罗红,庞厚清,等.儿童至青春期子宫卵巢超声测值及超声对性早熟的诊断价值[J].四川大学学报(医学版),2019,50(4): 583-587.
[16]Cai XD,Li Z,Bai M,et al.Effects of different doses of gonadotro-
pin-releasing hormone analogs on hypothalamic-pituitary-gonadal ax-is in girls with precocious puberty[J].Chinese Journal of Pediatrics, 2015,21(7):18-21.
蔡锡顶,李珍,白敏,等.不同剂量促性腺激素释放激素类似物对性早熟女童下丘脑-垂体-性腺轴的影响[J].儿科药学杂志,2015,21
(7):18-21.
[17]Ma XY,Lu WL,Ni JH,et al.Application value of total quantitative
measurement of urinary gonadotropin in predicting the type of early breast development in girls[J].Diagnostics Theory&Practice,2019, 18(3):291-295.
马晓宇,陆文丽,倪继红,等.尿促性腺激素全定量测定在预测女童乳房早发育类型中的应用价值[J].诊断学理论与实践,2019,18
(3):291-295.
(收稿日期:2022-03-30)
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