骨龄指数在儿童性早熟诊断中的临床意义

目的:探讨性早熟患儿骨龄指数(BAI)与促性腺激素释放激素(GnRH)激发试验各指标之间的相关性.方法:对临床诊断为性早熟的38例女童均做GnRH激发试验,进行左手腕正位X线摄影并用中国人手腕骨骨龄评价方法与标准(CHN法)测骨龄,骨龄除以实际年龄得BAI,根据临床表现和实验室结果将患儿分为特发性中枢性性早熟(ICPP)组和外周性性早熟(PPP)组,并分别对ICPP组和PPP组女童的BAI与GnRH激发试验各指标做相关性分析.结果:(1)GnRH激发试验前后2组促黄体生成素(LH)和卵泡刺激素(FSH)基础值间差异无统计学意义(P＞0.05),LH和FSH峰值均较基础值明显升高,且2组间LH峰、LH/FSH差异均有统计学意义(P＜0.01).(2)ICPP组骨龄较实际年龄明显提前,差异有统计学意义(t=2.756,P＜0.05),PPP组骨龄虽较实际年龄有所提前,但差异无统计学意义(t=0.308,P＞ 0.05).(3)ICPP组BAI与LH峰、FSH峰、LH/FSH峰之间呈正相关(r分别为0.684,0.544和0.753,P＜ 0.05或P＜0.01).结论:BAI越大中枢性性早熟可能性越大,越需要做GnRH激发试验.

The Clinical Significance of Bone Age Index in the Diagnosis of Child Sexual Precocity

Objective: To detect the correlation between bone age index(BAI) and index of gonadotropin releasing hor mone(GnRH) stimulation tests for precocious children.Methods: GnRH stimulation tests were detected in 38 girls diag nosed sexual precocity.The left wrist X-ray test was performed in subjects.Chinese wrist bone age assessment method and standard-CHN method were used to determine the bone age.BAI is equal to the bone age divided by actual age.Thirty-eight girls were divided into idiopathic precocious puberty(ICPP) group and peripheral precocious puberty(PPP) group according to the clinical symptom and laboratory results.The correlation of BAI and index of GnRH stimulation tests were analyzed be tween two groups.Results:(1)There was no significant difference in luteinizing hormone(LH) and follicle stimulating hor mone(FSH) baseline before and after GnRH stimulation(P > 0.05).However,peak values of LH and FSH were obviously higher than that of baseline,and differences of LH peak and LH/FSH were significant between two groups(P < 0.01).(2)The bone age was significantly advanced than actual age in ICPP group(t= 2.756,P< 0.05).The bone age was earlier than the ac tual age in PPP group,but no significant difference(t = 0.308,P > 0.05).(3) There was a positive correlation between BAI and LH peak,FSH peak and ratio of LH/ FSH peak in ICPP group(r = 0.684,0.544 and 0.753,P < 0.05 or P < 0.01).Con clusion: There was a more possible of ICPP when BAI was higher,in which GnRH stimulation test was more necessary.