HCG与外用睾酮霜治疗小阴茎的临床疗效观察

目的 探寻临床治疗小阴茎的有效治疗办法及其选择用药的依据.方法 按照小阴茎诊断标准选择病例,分为HCG组(肌注HCG,每次1000IU,每周2次,连用6周)和T组(每日外用睾酮霜2次),并于治疗前后测定阴茎长度、睾丸大小及性激素水平等以观察其疗效及影响.结果 阴茎长度测量:用药前两组阴茎长度比较无显著差异(P>0.05),而用药后两组均有显著增长(P<0.05),但两组用药后增加值比较无显著差异(P>0.05).睾丸体积测量:用药前两组睾丸体积比较无显著差异(P>0.05),但HCG组用药后有显著增长(P<0.05),而睾酮组用药后睾丸体积仪稍有增长(P>0.05).激素水平测定:除HCG组用药前后睾酮水平比较有显著性差异(P<0.05)外,其他各检测指标均无明显变化.疗效:HCG组中7例显效、5例有效、4例无效;T组中6例显效、7例有效、2例无效.两组比较疗效无显著性差异(P>0.05).结论 肌注HCG和外用睾酮霜治疗儿童小阴茎均可使阴茎明显的增长,且对性激素水平无明显干扰,并与患儿年龄大小无关.但外用睾酮霜更为方便实用,在为使睾丸得到同步增长时也可首选HCG治疗.西药治疗无效时应想到雄激素抵抗综合症可能.     

脐血瘦素、胰岛素样生长因子-Ⅰ与胎儿生长发育

目的 揭示脐血瘦素及胰岛素样生长因子-Ⅰ(IGF-Ⅰ)与胎儿生长发育的关系,探讨其在胎儿生长发育方面的相互作用及临床意义.方法 采用放射免疫法测定86例新生儿脐血瘦素、IGF-Ⅰ水平,根据胎龄及出生体重百分位数的关系分为:小于胎龄儿(SGA)组16例、适于胎龄儿(AGA)组41例及大于胎龄儿(LGA)组29例.同时测量新生儿的出生体重、身长、头围、足长、胎盘重量并计算体质指数(BMI).结果 ①脐血瘦素水平SGA组与AGA组间差异有统计学意义(P<0.05);脐血IGF-Ⅰ水平AGA与LGA组间差异有统计学意义(P<0.05).②脐血瘦素及IGF-Ⅰ水平分别与新生儿出生体重、身长、头围、足长、BMI及胎盘重量呈显著正相关(P<0.01),脐血瘦素与IGF-Ⅰ水平亦呈显著正相关(P<0.01).③脐血瘦素水平与新生儿性别及分娩方式间差异均无统计学意义(P>0.05);脐血IGF-Ⅰ水平与新生儿性别差异无统计学意义(P>0.05),与新生儿分娩方式差异有统计学意义(P<0.05).结论 脐血瘦素、IGF-Ⅰ在调节胎儿生长发育方面起着重要作用,参与胎儿的生长发育过程,可作为评价胎儿生长发育及营养状态的临床指标之一.脐血瘦素、IGF-Ⅰ水平异常可能是引起胎儿宫内生长迟缓和巨大儿发生的原因之一.     

基于GAMLSS方法对儿童青少年阴茎生长发育的研究

目的研究0~16岁儿童青少年阴茎发育情况,绘制各年龄段阴茎发育情况的百分位数曲线。方法通过简单随机抽样和分层整群抽样选取重庆地区3024名0~16岁正常男性新生儿和儿童青少年为研究对象,对其进行阴茎长度和直径的测量。运用描述性统计学分析重庆地区儿童青少年阴茎的数据特点,采用广义可加模型(GAMLSS)拟合模型绘制P_3、P_(10)、P_(25)、P_(50)、P_(75)、P_(90)、P_(97)的百分位数曲线图,获得其百分位数参考值。结果阴茎长度和阴茎直径在1岁以前增长快速,1~11岁期间增长缓慢,11岁后又进入快速增长期。阴茎长度和直径呈正相关(r=0.961,P0.01)。获得了各年龄段阴茎长度和阴茎直径的各百分位数参考值,拟合了百分位数曲线。结论重庆地区男性儿童青少年的阴茎长度和阴茎直径的生长发育过程一致,0~1岁和11~16岁这两个时期为阴茎长度和阴茎直径的快速增长期;并建立了重庆地区0~16岁儿童青少年阴茎长度和阴茎直径的百分位曲线图,为进一步研究儿童青少年性发育提供了参考数据。     

男童一侧睾丸缺失对另侧睾丸影响的研究

目的探讨男童一侧睾丸缺失后对另侧睾丸的生长、性激素水平及第二性征发育的影响。方法对61例一侧睾丸缺失的患儿进行随访，随访内容包括所剩睾丸体积、性激素水平及第二性征发育情况。同期检测150例各年龄段正常男孩相应指标。按≤10岁、10～12岁、〉12岁，分年龄段分别进行比较。结果各年龄段内，睾丸缺失组睾丸体积与对照组比较，差异均有统计学意义俨〈0．05），睾丸缺失的不同疾病组之间比较，无统计学意义（尸〉0．05）；睾丸缺失早期另侧睾丸肥大明显，并随缺失时间延长而减轻；10～12岁及〉12岁组肥大尤为明显，与≤10岁组比较，差异有统计学意义（P〈0．05）；性激素水平随年龄增长而增加，但相同年龄段内，睾丸缺失组与对照组比较，差异无统计学意义（P〉0．05）；睾丸缺失患儿第二性征的出现及发育与正常儿童无明显差异。结论男童一侧睾丸缺失可致另侧睾丸代偿性肥大（CTA）。术后早期睾丸代偿增大更为明显；睾丸发育启动及增长发育期睾丸代偿肥大较处于相对静止期更为明显。但其增大程度与引起缺失的原发疾病无明显关系，且CTA不影响其后的性激素水平及青春期第二性征的出现。     

Visfatin in IUGR:cord blood level and mRNA expression in placenta

目的 探讨内脂索与胎儿生长发育的关系.方法 选择2008年12月-2010年6月足月出生的宫内发育迟缓(IUGR)儿、巨大儿及正常足月儿各35例,采用EUSA法测定脐血内脂素水平,Real-time PCR法检测胎盘内脂素mRNA相对含量,放射免疫法测定脐血胰岛素水平;分析脐血内脂素、胰岛素水平、胎盘内脂素mRNA相对含量与出生体质量的关系及脐血内脂素、胰岛素水平与胎盘内脂素mRNA相对含量间的关系.结果 IUGR儿脐血内脂素水平高于巨大儿及正常足月儿,差异有统计学意义(P<0.05);巨大儿与正常足月儿之间脐血内脂素水平差异无统计学意义(P>0.05).三组间新生儿脐血胰岛素水平差异有统计学意义(P0.05).三组间胎盘内脂素mRNA表达差异无统计学意义(P>0.05),胎盘内脂素mRNA水平与出生体质量、脐血内脂素、胰岛素水平均无相关性(P>0.05).结论 新生儿期内脂素与IUGR有关,可通过调节代谢而影响胎儿宫内的生长发育.     

4854例青少年阴茎睾丸测量值的调查分析

目的 了解和评价青少年阴茎及睾丸的发育状态。方法 对长沙市4854名5—14岁中小学生进行了阴茎和睾丸大小测定，提出了长沙市男性儿童少年阴茎、睾丸发育的正常范围值。结果 男性儿童青少年阴茎长度和睾丸纵径与其年龄有明显关联，5～11岁之间增长缓慢，11岁后开始骤增，标志进入青春期。而阴茎周长和睾丸横径与其年龄无明显关联。结论 男性儿童青少年阴茎长度和睾丸纵径是性发育的指征之一，可以用来初步评价其性发育情况。而阴茎周长和睾丸横径不能作为性发育特征来观察。     

不同年龄段漏斗胸患儿手术前后胸廓的扁平程度

目的 探讨不同年龄段漏斗胸患儿手术前后胸廓扁平程度与年龄变化的关系,为临床选择恰当的手术时机提供参考依据.方法 随机选取2003年7月-2005年7月本院住院的漏斗胸患儿70例.其中1～3岁25例,>3～6岁25例,>6岁20例.均行改良Ravitch术矫治,术前和术后2 a分别摄胸部标准正侧位片,测量胸廓扁平指数.手术前后分别选择一般情况与患儿相当的无胸廓畸形儿童作为术前、术后对照组,术后另选择一般情况与患儿相当的未手术漏斗胸患儿作为未手术对照组.结果 不同年龄段对照组组间胸廓扁平指数比较无显著性差异(P>0.05);病例组术前与术前对照组比较有显著性差异(P<0.05);病例组术前组间比较差异显著(P<0.05),且年龄越大,胸廓扁平指数越大;各病例组术后与术后对照组比较有显著性差异(P<0.05),胸廓扁平指数未完全恢复至正常水平,但术后与未手术对照组比较有显著性差异(P<0.05),胸廓扁平指数较术前减小,且年龄越小,术后胸廓扁平指数越小.结论 各年龄组漏斗胸患儿术前胸廓较健康同龄儿章扁平,且胸廓扁平程度随年龄增长而加重;术后2 a漏斗胸患儿胸廓扁平程度未能达到正常水平,但较同龄未手术患儿有明显改善,且手术年龄越小,术后改善越明显;漏斗胸应早期手术,最恰当的手术年龄为1～3岁.     

单纯肥胖儿童618例睾丸容积超声检测结果及对比分析

目的　探讨睾丸容积超声检测的优越性 ;明确单纯肥胖与正常儿童睾丸发育之差异 ;分析Kaup指数变化对儿童睾丸发育可能产生的影响。方法　①将超声测量三径并计算出睾丸容积均值 (MVT)的 6 18例 7～ 14岁的肥胖男童 ,按年龄分为 8个年龄段 ;同样方法检测相应年龄段正常男童 6 0 3例作为对照组 ,进行MVT测量结果的比较与评价 ;②另对两组中年龄段为 12岁、年龄差限制在 6个月以内、身高分组差值≤ 5cm各 5 1例 ,进行MVT 1∶1的配对资料比较及Kaup指数变化对MVT影响的分析。 结果　 7～ 14岁各年龄段肥胖组与对照组MVT的对比结果均有极显著差异 (P <0 0 1)。两组 12岁男童MVT 1∶1配对资料比较结果仍有极显著性差异(P <0 0 1) ;对照组Kaup指数为 15～ 2 0 ,体重及身高增长同MVT发育有极显著的相关性 (P <0 0 1) ;而肥胖组Kaup指数 >2 0 ,上述的相关指标无显著意义 (P >0 0 5 )。结论　两组 7～ 14岁儿童MVT比较结果均有极显著差异。分析发现 ,由于两组Kaup指数的不同 ,而导致儿童身高及体重的增长与睾丸发育之间的相关关系的差异。因此 ,可能明显影响了肥胖儿童睾丸的发育。     

促性腺激素治疗对多种垂体激素缺乏症男性患者睾丸形态和功能影响的时效性

目的研究人绒毛膜促性腺激素(hCG)和人绝经期促性腺激素(hMG)起始治疗年龄对多种垂体激素缺乏症男性患者的睾丸形态和功能改善情况的影响。方法以多种垂体激素缺乏症男性患者为研究对象,给予hCG和hMG治疗,同时维持其他激素正常,观察睾丸、阴茎形态,促性激素水平,身高,骨龄等变化值与开始治疗年龄的相关性。结果入组的54例患者经hCG和hMG治疗6个月后,阴茎长度由治疗前的(2.58±0.69)cm增长至(4.19±0.77)cm,阴茎周长由治疗前的(3.71±1.36)cm增长至(5.95±1.26)cm,睾丸容积从治疗前的(1.76±1.49)ml增加至(5.20±2.30)ml,身高从治疗前的(147.01±12.29)cm增加至(151.98±11.52)cm,骨龄从治疗前的(11.22±2.71)岁增长至(11.64±2.72)岁,差异均有统计学意义(P0.01)。睾丸容积及睾酮水平在治疗前、后的增长值随年龄增长均呈降低趋势,在各年龄组间的差异均有统计学意义(P均0.05)。用药前后睾丸容积增长值、血清促卵泡激素(FSH)和黄体生成素(LH)水平增加值以及用药前后身高增长值均与开始治疗年龄呈负相关(r=-0.517~-0.334,P0.05)。结论在正常青春期时期适当早期给予多种垂体激素缺乏症男性患者hCG和hMG治疗可更好改善其第二性征和睾丸功能。     

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目的探讨孤独症患儿头围发育情况。方法研究对象为中国医科大学附属盛京医院2009年9月至2011年6月确诊的孤独症患儿(孤独症组)156例,其中≤3岁74例,>3岁82例。同时选择健康儿童141名作为正常对照组,其中≤3岁58名,>3岁83名。分别测量两组头围并进行组间比较。结果孤独症组≤3岁患儿头围平均值与大头所占比例均大于正常对照组,两组差异有统计学意义(P<0.05)。孤独症组>3岁患儿头围平均值与大头所占比例与健康儿童基本相似,两组差异无统计学意义(P>0.05)。在除外大头患儿后,两组头围平均值比较差异无统计学意义(P>0.05)。结论孤独症患儿生后早期头围偏大,并且常伴大头,头围异常也是患儿重要的临床特征之一。了解孤独症头围发育可为孤独症的发病机制提供参考依据。     

Congenital hypogonadotropic hypogonadism and micropenis: effect of testosterone treatment on adult penile size why sex reversal is not indicated

Micropenis is commonly due to fetal testosterone deficiency. The clinical management of this form of micropenis has been contentious, with disagreement about the capacity of testosterone treatment to induce a functionally adequate adult penis. As a consequence, some clinicians recommend sex reversal of affected male infants. We studied 8 male subjects with micropenis secondary to congenital pituitary gonadotropin deficiency from infancy or childhood to maturity (ages 18 to 27 years). Four patients were treated with testosterone before 2 years of age (group I) and four between age 6 and 13 years (group II). At presentation, the mean penile length in group I was 1.1 cm (-4 SD; range, 0.5 to 1.5 cm) and in group II it was 2.7 cm (-3.4 SD; range, 1.5 to 3.5 cm). All patients received one or more courses of 3 intramuscular injections of testosterone enanthate (25 or 50 mg) at 4-week intervals in infancy or childhood. At the age of puberty the dose was gradually increased to 200 mg monthly and later to an adult replacement regimen. As adults, both group I and II had attained a mean final penile length of 10.3 cm 2.7 cm with a range of 8 to 14 cm (mean adult stretched penile length for Caucasians is 12.4 2.7 cm). Six of 8 men were sexually active, and all reported normal male gender identity and psychosocial behavior. We conclude that 1 or 2 short courses of testosterone therapy in infancy and childhood augment penile size into the normal range for age in boys with micropenis secondary to fetal testosterone deficiency; replacement therapy at the age of puberty results in an adult size penis within 2 SD of the mean. We found no clinical, psychologic, or physiologic indications to support conversion of affected male infants to girls. Further, the results of this study do not support the notion, derived from data in the rat, that testosterone treatment in infancy or childhood impairs penile growth in adolescence and compromises adult penile length.     

Growth and Maturation in the Male Genitalia From Birth to Adolescence II. Change of Penile Length

Penile lengths of Japanese males from birth to adolescence were studied in cross-sectional series. The mean length of the penis in 5 days term newborn was 2.9 ± 0.5 cm (M ± SD). There was a gradual increase in penile length from the age 1 to 11 years. After 12 years of age there was a sudden increase in length. The mean length increased from 5.5 ± 1.5 cm at the age of 12 to 8.3 ± 0.8 cm at 14 years. The largest increment was observed between the age of 13 and 14 years. Mean penile length increased from 4.9 ± 0.8 cm at stage I of pubic hair development to 7.2 ± 1.4 cm at stage II and 9.0 ± 1.0 cm at stages IV-V. The largest increment was observed between stage I and stage II of pubic hair development. This new reference of penile length can be helpful in those cases in which the children is suspective of having genitals of abnormal size.     

Normative data of penile length for term Chinese newborns

Careful examination and assessment of penile length in the newborn is important because micropenis is associated with hypothalamic disorders. This prospective cross-sectional study was designed to establish the norm of penile length for term Hong Kong Chinese newborns. 4,628 full-term healthy male newborns were enrolled in the study. Penile length was measured from pubic ramus to the tip of the glans penis by placing the end of a straight edge ruler against the pubic ramus. A gestation-associated graph of 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles for the penile length was created. The penile length was significantly correlated with gestational age, birth weight and body length. When compared with published data for other populations, Hong Kong newborns have significantly shorter penile length. The norm of the penile length is useful in diagnostic and therapeutics for the ethnic Chinese male newborns.     

Penile anthropometry of normal prepubertal boys in Turkey

Aim: The age‐related values of penile length must be known to determine abnormal penis sizes and to follow the treatment of underlying diseases. The aim of this study is to evaluate abnormal penile length in Turkish children by establishing novel reference values for Turkish population and to compare the mean penile length and other parameters with alternates from different ethnic populations and geography. Methods: This cross‐sectional study was conducted on a voluntary basis between November 2008 and November 2009 from four centres in Turkey and comprised of 1278 healthy volunteered prepubertal children. Complete stretched penile length and penis circumference measurements were used for penile length and penis circumference evaluations, respectively. All measurements were taken twice by only one investigator, and mean values were recorded. Results: Penile length and penis circumference for every age group were obtained, percentile curves were established and these findings were compared with the results of previous studies. Significant differences were found between penile length of Turkish children and recently used reference values. Conclusion: With this study, novel reference values for penile length in prepubertal children were presented to the literature.     

尿道下裂术后阴茎外观及性功能的远期随访

目的 远期随访手术治疗的尿道下裂病例.评价阴茎外观、性功能,探讨二者的关系.方法 通过信访、电话采访及面访,随访1984至1992年间在我院手术治疗的174例尿道下裂患者,做统计学分析.结果 仅43例获得完整的随访资料,受访者平均年龄21.6岁,53.5%的受访者不满意阴茎外观,主要嫌阴茎短小或下弯,83.7%的受访者对性功能满意,76.7%勃起质量优良,23.3%勃起不良,主要为勃起时阴茎短小或下弯,39.5%射精不良.主要为射精无力,已经历性生活者18例,88.9%无性交障碍,依患者自己对阴茎外观满意程度作比较,"满意组"的勃起(P<0.025)和射精(P<0.025)不良问题较少.有性经历的比例高(P<0.05).阴茎外观与性功能的总体评价呈正相关(r=0.469,P<0.01).结论 尿道下裂患者对阴茎外观的关注程度高,阴茎大小影响阴茎外观和性功能的满意度.部分患者成年后存在勃起、射精或性交问题,但多数人性功能状况良好.阴茎外观越好,性功能越好.     

青春期前儿童阴茎发育不良的治疗探讨

目的探讨青春期前儿童阴茎发育不良的最佳治疗方法。方法近10年来作者收治阴茎测量值低于当地儿童青少年正常标准1～2．5个标准差的青春期前阴茎发育不良患儿1385例，性激素水平无明显异常，依据治疗方法，分为物理治疗组、绒毛膜促性腺激素（HCG）治疗组以及综合治疗组，另设确诊病例但未行治疗为同期对照组。计算治疗前及治疗后3个月、1年、5年的阴茎测量指数，对各组阴茎发育不良治疗有效率进行比较。结果物理治疗组经1个疗程后3个月复诊，阴茎发育明显改善34／169例，1年后阴茎发育明显改善3／169例。HCG治疗组1个疗程后3个月复诊，阴茎发育明显改善192／265例，1年后阴茎发育明显改善212／265例，5年后阴茎测量值达同龄儿正常标准以上204／265例。综合治疗组1个疗程后3个月复诊，阴茎发育明显改善916／951例，1年后阴茎发育明显改善922／951例，5年后阴茎发育达同龄儿正常标准以上928／951例。各组比较，1个疗程后3个月，HCG及综合治疗组阴茎发育改善率均显著高于物理治疗组。长期疗效评定：1年后综合治疗组阴茎发育改善率显著高于HCG治疗组（P〈0．05）；经5年长期随访，综合治疗组完全治愈率亦明显高于HCG治疗组（P〈0．05）。结论联用物理治疗仪、中药及HCG的综合治疗，是目前治疗青春期前儿童阴茎发育不良较为理想的方法。     

Prevalence of micropenis among boys from different regions of Bulgaria

AIMS: Micropenis is a normally formed penis whose length is more than 2.5 SD below the mean penile length for age. However, the definition of this disorder depends on penile length norms. METHODS: Penile length, circumference and anthropometric values of 310 boys under one year of age from five regions in Bulgaria were investigated. RESULTS: The mean penile length for all boys was 3.55 +/- 0.46 cm, thus micropenis could be defined as a penile length below 2.40 cm. However, regional differences were observed in penile length and circumference. According to regional mean values and the appropriate definition of micropenis, only two of the children had micropenis. CONCLUSIONS: In a prospective study of Bulgarian boys we established wide regional variations of normal penile length. Consequently, the diagnostic and therapeutic approach to micropenis should consider the mono-ethnic inter-regional differences.     

Penile length nomogram for Asian Indian prepubertal boys

BackgroundPenile length-for-age nomograms in prepubertal boys may aid in early recognition of endocrine and genetic disorders associated with abnormal phallic size. There are scarce data on the penile length measurements in children beyond the neonatal period and there is a lack of such a nomogram for Asian Indians.Materials and methodsOf the boys who were admitted in our ward or seen in the outpatient setting for genitalia-unrelated surgical problems, 20 consecutive boys were included in each of the following ten age slots (total of 200 subjects): 0–1, 1–2, 2–3, 3–4, 4–5, 5–6, 6–7, 7–8, 8–9, and 9–10 years. Their stretched penile length (SPL) measurements were used to establish the normal range (mean ± 2 SD) of penile length-for-age in prepubertal Indian boys. Mean ± 2.5 SD was also calculated to define the cut-offs for micropenis and macropenis, respectively, in each age group.ResultsA rapid increase is seen in penile length up to 4 years of age. A much slower increase is implied thereafter.ConclusionThis study provides reference values of penile lengths for Asian Indian boys aged 0–10 years.