目的 分析女童性早熟发病的影响因素,为儿童卫生保健提供依据。方法 选取2019年10月—2022年8月天津市妇女儿童保健中心收治的性早熟女童177例作为病例组,通过健康查体招募健康女童354例(按年龄1∶2匹配)作为对照组。收集两组女童的年龄、行为方式等,测量身高和体重并计算体质量指数(BMI)。两组间比较采用t检验或χ2检验,采用Logistic回归模型进行多因素分析。结果 病例组和对照组女童年龄分别为(7.72±1.02)岁和(7.60±1.05)岁,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,腰围大(OR=1.11,95%CI:1.07～1.15)、视屏时间>1h/d(OR=4.35,95%CI:2.62～7.22)、中高强度体力活动≤1h/d(OR=3.14,95%CI:1.71～5.75)、塑料桶/瓶装水饮用比例高(OR=1.02,95%CI:1.01～1.03)是女童性早熟的危险因素(P＜0.05);母亲月经初潮年龄大(OR=0.59,95%CI:0.45～0.76)、父亲首次遗精年龄大(OR=0.67,95%CI:0.53～0.85)、午睡时间长(OR=0.97,95%CI:0.96～0.98)是女童性早熟的保护因素(P＜0.05)。结论 建议加强儿童与家长的健康教育,帮助其养成良好的日常行为习惯,以预防女童性早熟的发生。
Abstract
Objective To analyze the influencing factors of precocious puberty in girls, in order to provide evidence for children's healthcare. Methods A total of 177 precocious puberty girls treated in Tianjin Women and Children's Health Center between October 2019 and August 2022 were recruited as the case group, and 354 healthy girls matched 1∶2 by age were selected as the control group based on routine physical examination. Information of age, behavior factors were collected, height and body weight were recorded and body mass index(BMI) was calculated. The comparison between the two groups was performed using the t test or the χ2 test. Logistic regression model was used to determine the potential influencing factors of precocious puberty. Results The average age of girls in case and control groups were (7.72±1.02) and (7.60±1.05) years old, respectively,and the difference was not significant (P>0.05). Multivariate Logistic regression analysis showed that larger waist circumference(OR=1.11, 95%CI: 1.07 - 1.15), screen time ＞1h/d(OR=4.35, 95%CI: 2.62 - 7.22), moderate-to-vigorous physical activity ≤1h/d(OR=3.14, 95%CI: 1.71 - 5.75), and higher ratio of plastic bottled water(OR=1.02, 95%CI:1.01 - 1.03) were risk factors, and mother's older age at menarche(OR=0.59, 95%CI:0.45 - 0.76), father's older age of first spermatorrhea(OR=0.67, 95%CI: 0.53 - 0.85), and longer nap time(OR=0.97, 95%CI: 0.96 - 0.98) were protective factors for precocious puberty in girls(P＜0.05). Conclusion Health education should be strengthened to help children establish good behavior habits to reduce the risk of precocious puberty in girls.
关键词
性早熟 /
女童 /
家庭因素 /
行为因素 /
生活方式
Key words
precocious puberty /
girls /
family factors /
behavioral factors /
lifestyle
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Bradley SH, Lawrence N, Steele C, et al. Precocious puberty[J]. BMJ,2020,368:l6597.
[2] 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. 中枢性性早熟诊断与治疗专家共识(2022)[J].中华儿科杂志,2023,61(1):16-22.
The Subspecialty Group of Endocrinologic, Hereditary and Metabolic Diseases, the Society of Pediatrics, Chinese Medical Association,the Editorial Board, Chinese Journal of Pediatrics. Expert consensus on the diagnosis and treatment of central precocious puberty(2022)[J].Chin J Pediatr,2023,61(1): 16-22.(in Chinese)
[3] Yoo JH. Effects of early menarche on physical and psychosocial health problems in adolescent girls and adult women[J].Korean J Pediatr,2016,59(9): 355-361.
[4] Liu Y, Yu T, Li X, et al. Prevalence of precocious puberty among Chinese children: A school population-based study[J].Endocrine,2021,72(2): 573-581.
[5] Stagi S, De Masi S, Bencini E, et al. Increased incidence of precocious and accelerated puberty in females during and after the Italian lockdown for the coronavirus 2019(COVID-19) pandemic[J].Ital J Pediatr,2020,46(1): 165.
[6] Busch AS, Hagen CP, Assens M, et al. Differential impact of genetic loci on age at thelarche and menarche in healthy girls[J].J Clin Endocrinol Metab,2018,103(1): 228-234.
[7] Macedo DB, Silveira LF, Bessa DS, et al. Sexual precocity-genetic bases of central precocious puberty and autonomous gonadal activation[J].Endocr Dev,2016,29: 50-71.
[8] 吴春红,朱乔波,邵东良,等.膳食对学龄期女童性早熟的影响[J].中国妇幼健康研究,2021,32(6):847-852.
Wu CH, Zhu QB, Shao DL, et al. Influence of diet on precocious puberty in school-age girls[J].Chin J Woman Child Health Res,2021,32(6): 847-852.(in Chinese)
[9] 魏莹,周润雪,牛婧娅.中枢性性早熟遗传学研究进展[J].国际内分泌代谢杂志, 2020,40(6):416-419.
Wei Y,Zhou RX, Niu JY.Advances of genetics of central precocious puberty[J].Int J Endocrinol Metab, 2020,40(6): 416-419.(in Chinese)
[10] Dong Y, Jan C, Ma Y, et al. Economic development and the nutritional status of Chinese school-aged children and adolescents from 1995 to 2014: An analysis of five successive national surveys[J].Lancet Diabetes Endocrinol,2019,7(4): 288-299.
[11] Shi L,Jiang Z,Zhang L.Childhood obesity and central precocious puberty[J].Front Endocrinol(Lausanne),2022,13:1056871.
[12] Calcaterra V, Magenes VC, Hruby C, et al. Links between childhood obesity, high-fat diet, and central precocious puberty[J].Children(Basel), 2023,10(2): 241.
[13] Suh J, Choi HS, Kwon A, et al. Effect of agricultural pesticide on precocious puberty in urban children: An exploratory study[J].Clin Exp Pediatr,2020,63(4): 146-150.
[14] 刘一凡.中国广东中山儿童性早熟的横断面调查研究[D].广州:南方医科大学,2022.
Liu YF. A cross-sectional study of precocious puberty in children in Zhongshan, Guangdong, China[D]. Guangzhou: Southern Medical University, 2022.(in Chinese)
[15] 支金草,裴飞,张世雯,等.新型冠状病毒肺炎流行期间儿童和青少年的心理行为问题:Scoping综述[J].中国当代儿科杂志,2022,24(7):728-735.
Zhi JC, Pei F, Zhang SW, et al. Psychological and behavioral problems in children and adolescents during the coronavirus disease 2019 epidemic:A scoping review[J].Chin J Contemp Pediatr,2022,24(7): 728-735.(in Chinese)
[16] Alcocer Alkureishi L.Central precocious puberty and blue screen time in rats-an endocrinologist's thoughts on what this might mean for pediatric patients[J]. Pediatr Ann, 2023,52(1): e1-e3.
[17] Shokri E, Heidarianpour A,Razavi Z. Positive effect of combined exercise on adipokines levels and pubertal signs in overweight and obese girls with central precocious puberty[J]. Lipids Health Dis,2021,20(1): 152.
[18] Atuegbu CM, Meludu SC, Dioka CE, et al. Effect of moderate-vigorous intensity physical exercise on female sex hormones in premenopausal university students in Nnewi[J].Nigeria Int J Res Med Sci,2014,5(4):1516-1520.
[19] 白祥梦.安徽阜阳地区性早熟女童的环境激素暴露水平研究[D].合肥:安徽医科大学, 2022.
Bai XM.Study on environmental hormone exposure of precocious girls in Fuyang,Anhui province[D]. Hefei: Anhui Medical University, 2022.(in Chinese)
基金
天津市医学重点学科(专科)建设项目(TJYXZDXK-075C)
PDF(628 KB)
