| Background and purpose:Sexual precocious puberty refers to girls exhibiting secondary sexual characteristics before the age of 8 and boys before the age of 9,which are divided into central(gonadotropin-releasing hormone-dependent)sexual precocity and peripheral(non-gonadotropin-releasing)according to the pathogenesis and clinical manifestations Hormone dependence)Sexual precocity,formerly known as true sexual precocious puberty and pseudo sexual precocious puberty,and part of it is incomplete sexual precocious puberty(or partial,variant youth development)is a variation of sexual precocity,including simple breast premature Simple pubic hair appears early and simple early menarche.Most of the early breast development of infants and young children is manifested as simple early breast development(PT).With the development of society and the improvement of nutritional status,the incidence rate has increased year by year.The current research shows that most of them are related to small adolescence,and they can be free within 3 years of age.It subsides,but 13%-20% will progress to central precocious puberty;central sexual precocious puberty will cause adult height impairment and cause some social and psychological disorders;it is even related to breast cancer,germ cell tumors,and metabolic syndrome.Gonadotropin-releasing hormone(GnRH)stimulation test is the gold standard for evaluating whether the gonad axis is activated in children.However,due to the existence of hyperpuberty in young puberty,the diagnostic criteria of GnRH stimulation test are not fully applicable to infants and young children;The laboratory index of whether the early developmental gonadal axis is activated is difficult to distinguish whether it is central precocious puberty,and the diagnosis and treatment are delayed.Sex hormone binding globulin(SHBG)is a glycoprotein secreted by the liver.Its main function is to specifically bind and transport sex hormones in plasma.This subject studies the clinical application value of SHBG in 1-3 year old girls with early breast development by observing the changes of sex hormone binding globulin(SHBG)levels at different sexual development levels of 1-3 year old girls,and guides the clinical diagnosis.Objects and methods:A total of 60 girls aged 1-3 years old who were treated in the outpatient department of the Endocrinology Department of Jiangxi Provincial Children's Hospital due to breast development were continuously collected by an endocrinologist to collect the signs of the child: height?weight?whether there is hairiness,breast staging,axillary hair staging,pubic hair Staging,whether there are secretions in the vulva;B-mode ultrasound examination(uterine size,ovarian size);left hand and wrist X-ray examination(bone age),to determine the bone age size by Greulich-Pyle method(fixed by one person)Experienced doctors uniformly read the film);laboratory tests: estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL),sex hormone binding globulin(SHBG)),Perfect GnRH challenge test for suspected central precocious puberty.It is divided into two groups according to development status.Experimental group A has breast tanner stage greater than stage ?,with or without other early symptoms of sexual development: advanced bone age(bone age is older than 1 year),enlarged uterus(uterine long diameter> 34mm),axillary hair,pubic hair,vaginal bleeding,vulvar secretion),or breast tanner stage ? with more than one symptom of early sexual development;experiment B The group showed only breast development,and the breast tanner stage was stage ?.In addition,30 girls aged 1-3 years old who came to Jiangxi Provincial Children's Hospital Children's Health Department for sexual health check-up were collected as a control group;compare the SHBG difference between two pairs,and analyze the relationship between SHBG and breast development,using SPSS Statistics 22.0 To analyze the data,the statistical methods used include independent sample t test,pearson correlation analysis,set the test level of ? = 0.05,P <? difference is statistically significant.Results:A total of 90 eligible children were included in this study,30 cases in experimental group A,30 cases in experimental group B,and 30 cases in control group.(1)Comparison of the ages of the experimental group A,experimental group B and control group: the average age of the experimental group A is 2.27 ± 0.53 years old,the average age of the experimental group B is 2.06 ± 0.63 years old,the average age of the control group is 2.17 ± 0.42 years old,two independent lines of t test,P was greater than 0.05,the difference was not statistically significant,and there was no difference in age between the two groups;(2)The test group A and group B were tested for estradiol,the average of group A was 15.36 ± 5.68 pg / ml,and the average of group B was 24.17 ± 4.64 pg / ml,P = 0.327,the difference was not statistically significant,and there was no difference in estradiol between the two groups;(3)The LH of the experimental group A and the experimental group B was subjected to t test.The average LH of the experimental group A was 0.068 ± 0.31 mIu / ml The average LH of the experimental group B was 0.091 ± 0.088 mIu / ml,P = 0.184,the difference was not statistically significant,and there was no difference in the LH between the two groups;(4)The FSH of the experimental group A and the experimental group B was subjected to t test.4.74 ± 2.80 mIu / ml,the average FSH of the experimental group B is 2.81 ± 2.32 mIu / ml,P <0.01,the difference is statistically significant,the experimental group A is higher than the experimental group B;(5)the experimental group A and the experimental group B PRL line t test,the average PRL of the experimental group A was 8.04 ± 7.07 ng / ml,and the average PRL of the experimental group B was 9.92 ± 3.07 ng / ml,P = 0.409,the difference was not statistically significant.There is no difference in L;(6)The three groups of experiment A,experiment B and control group were compared between groups,and F test was performed.The results showed that the overall mean of SHBG levels in the three groups was not equal,F = 18.26,P <0.01,the difference was statistically significant Group A,Group B,and control group were compared with each other by SHBG.The t-test was performed: the average of Group A was 106.04 ± 33.28 nmol / L,Group B was 149.62 ± 36.28 nmol / L,and Group 149.98 ± 33.69 nmol / L Compared with SHBG in experiment A and experiment B,P <0.01,the difference was statistically significant,compared with SHBG in experiment A and control group,P <0.01,the difference was statistically significant,compared with SHBG in experiment B and control group,P = 0.554,the difference was not statistically significant,the SHBG of the experimental group A was higher than that of the experimental group B and the control group,and there was no significant difference between the experimental group B and the control group.(7)Correlation analysis of SHBG and FSH in the experimental group,the pearson correlation coefficient is 0.097,and there is no significant linear correlation between the two.In conclusion:(1)Sex hormone binding globulin is associated with the breasts of infants and young children.(2)SHBG can be used as an indicator to judge the progress of breast development of infants and young children.When SHBG decreases,SHBG should be closely followed and monitored for changes in SHBG,alerting to the occurrence of central precocious puberty. |
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