493 例特发性中枢性性早熟女孩的表现：一项单中心研究。
Presentation of 493 consecutive girls with idiopathic central precocious puberty: a single-center study.
机构信息
Université Paris Descartes and Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
出版信息
PLoS One. 2013 Jul 30;8(7):e70931. doi: 10.1371/journal.pone.0070931. Print 2013.
BACKGROUND
Despite the number of reported data concerning idiopathic central precocious puberty (CPP) in girls, major questions remain including its diagnosis, factors, and indications of gonadotropin releasing hormone (GnRH) analog treatment.
METHODS
A retrospective, single-center study was carried out on 493 girls with CPP.
RESULTS
Eleven girls (2.2%) were aged less than 3 years. Breast development was either isolated (Group 0, n = 99), or associated with one sign, pubic hair development, growth rate greater than 2 standard deviation score (SDS) or bone age (BA) >2 years above chronological age, (Group 1, n = 187), two signs (Group 2, n = 142) or three signs (Group 3, n = 65). The interval between onset of puberty and evaluation, body mass index (BMI) SDS, plasma luteinising hormone (LH) concentrations (basal and peak) and LH/ follicle-stimulating hormone (FSH) peak ratio after GnRH test, plasma estradiol and uterus length were significantly greater in Groups 2 and 3 than in Groups 0 and 1 respectively. 211 (42.8%) patients were obese and/or had excessive weight gain during the year before puberty. Obese girls more often had BA advance of >2 years (p = 0.0004) and pubic hair development (p = 0.003) than the others. BMI did not correlate with LH or with LH/FSH peak ratio. Girls with familial history of early puberty (41.4%) had greater frequencies of pubertal LH/FSH peak ratios (p = 0.02) than the others. During the 31 years of the study, there was no increase in the frequency of CPP or variation in its characteristics.
CONCLUSION
Obesity is associated with a higher BA advance and higher frequency of pubic or axillary hair development but not with LH secretion, suggesting that obesity accelerates adrenarche but not the maturation of the hypothalamic-pituitary-ovarian axis. The LH/FSH peak ratio was more frequently pubertal in girls with a familial history of early puberty, suggesting that this maturation depends on genetic factors.
背景
尽管已经有大量关于特发性中枢性性早熟（CPP）的报告数据，但仍存在许多问题，包括其诊断、发病因素和促性腺激素释放激素（GnRH）类似物治疗的指征。
方法
对 493 例 CPP 女孩进行了回顾性单中心研究。
结果
11 例（2.2%）女孩年龄小于 3 岁。乳房发育单纯性（0 组，n=99），或伴单一征象，阴毛发育，生长速度大于 2 个标准差评分（SDS）或骨龄（BA）比实际年龄大 2 年以上（1 组，n=187），2 个征象（2 组，n=142）或 3 个征象（3 组，n=65）。青春期开始至评估的时间间隔、体质指数（BMI）SDS、促性腺激素释放激素（GnRH）试验后血浆黄体生成素（LH）浓度（基础和峰值）和 LH/卵泡刺激素（FSH）峰值比、血浆雌二醇和子宫长度在 2 组和 3 组均显著大于 0 组和 1 组。211 例（42.8%）患者在性发育前一年肥胖和/或体重增加过多。肥胖女孩 BA 提前大于 2 年（p=0.0004）和阴毛发育（p=0.003）的发生率更高。BMI 与 LH 或 LH/FSH 峰值比均无相关性。有家族性性早熟史的女孩（41.4%）青春期 LH/FSH 峰值比的频率更高（p=0.02）。在 31 年的研究期间，CPP 的频率没有增加，其特征也没有变化。
结论
肥胖与 BA 提前更高和阴毛或腋毛发育的频率更高有关，但与 LH 分泌无关，提示肥胖加速肾上腺皮质功能亢进，但不加速下丘脑-垂体-卵巢轴的成熟。有家族性性早熟史的女孩 LH/FSH 峰值比更倾向于青春期，提示这种成熟取决于遗传因素。
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