婴儿发育与环境研究（TIDES）中的肛门生殖器距离和阴茎宽度测量：方法与预测因素
Anogenital distance and penile width measurements in The Infant Development and the Environment Study (TIDES): methods and predictors.
作者信息
Sathyanarayana Sheela, Grady Richard, Redmon J B, Ivicek Kristy, Barrett Emily, Janssen Sarah, Nguyen Ruby, Swan Shanna H
机构信息
Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA.
Seattle Children's Research Institute, Seattle, WA, USA.
出版信息
J Pediatr Urol. 2015 Apr;11(2):76.e1-6. doi: 10.1016/j.jpurol.2014.11.018. Epub 2015 Mar 7.
BACKGROUND
Anogenital distance (AGD) is an androgen responsive anatomic measurement that may have significant utility in clinical and epidemiological research studies. We describe development of standardized measurement methods and predictors of AGD outcomes.
METHODS
We examined infants born to 758 participants in The Infant Development and the Environment Study (TIDES cohort) in four clinical centers in 2011-2013. We developed and implemented a detailed training protocol that incorporated multiple quality control (QC) measures. In males, we measured anoscrotal distance (AGDAS), anopenile distance (AGDAP), and penile width (PW) and in females, anofourchette distance (AGDAF,) and anoclitoral distance (AGDAC). A single examiner obtained three repetitions of all measurements, and a second examiner obtained independent measurements for 14% of infants. We used the intra-rater ICC to assess within-examiner variability and the inter-rater ICC to assess between-examiner variability. We used multivariable linear regression to examine predictors of AGD outcomes including: gestational age at birth, birth weight, gestational age, several measures of body size, race, maternal age, and study center.
RESULTS
In the full TIDES cohort, including 758 mothers and children, significant predictors of AGD and PW included: age at exam, gestational age at birth, weight-for-length Z-score, maternal age and study center. In 371 males, the mean (SD) AGDAS, AGDAP, and PW were 24.7 (4.5), 49.6 (5.9), and 10.8 (1.3) mm, respectively. In 387 females, the mean (SD) AGDAF and AGDAC were 16.0 (3.2) mm and 36.7 (3.8) mm, respectively. The intra-examiner ICC and inter-examiner ICC averaged over all subjects and examiners were between 0.89-0.92 and 0.69-0.84 respectively.
CONCLUSIONS
Our study confirms that with appropriate training and quality control measures, AGD and PW measurements can be performed reliably and accurately in male and female infants. In order for reliable interpretation, these measurements should be adjusted for appropriate covariates in epidemiologic analysis.
背景
肛殖距（AGD）是一种雄激素反应性解剖学测量指标，在临床和流行病学研究中可能具有重要用途。我们描述了标准化测量方法的开发以及AGD结果的预测因素。
方法
我们对2011 - 2013年在四个临床中心参与婴儿发育与环境研究（TIDES队列）的758名参与者所生婴儿进行了检查。我们制定并实施了一项详细的培训方案，其中纳入了多项质量控制（QC）措施。对于男性，我们测量了肛门阴囊距离（AGDAS）、肛门阴茎距离（AGDAP）和阴茎宽度（PW）；对于女性，我们测量了阴唇系带距离（AGDAF）和阴蒂距离（AGDAC）。由一名检查者对所有测量进行三次重复测量，另一名检查者对14%的婴儿进行独立测量。我们使用检查者内ICC评估检查者内部的变异性，使用检查者间ICC评估检查者之间的变异性。我们使用多变量线性回归来检查AGD结果的预测因素，包括：出生时的胎龄、出生体重、孕周、几种身体尺寸测量值、种族、母亲年龄和研究中心。
结果
在整个TIDES队列中，包括758名母亲和儿童，AGD和PW的显著预测因素包括：检查时的年龄、出生时的胎龄、身长体重Z评分、母亲年龄和研究中心。在371名男性中，AGDAS、AGDAP和PW的均值（标准差）分别为24.7（4.5）、49.6（5.9）和10.8（1.3）mm。在387名女性中，AGDAF和AGDAC的均值（标准差）分别为16.0（3.2）mm和36.7（3.8）mm。所有受试者和检查者的检查者内ICC和检查者间ICC平均值分别在0.89 - 0.92和0.69 - 0.84之间。
结论
我们的研究证实，通过适当的培训和质量控制措施，可以在男婴和女婴中可靠且准确地进行AGD和PW测量。为了进行可靠的解释，在流行病学分析中应对这些测量值进行适当协变量的调整。
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