学龄前男童营养状况与尿促性腺激素及性激素水平的关系研究

背景　营养状况可能影响儿童体内促性腺激素（Gn）和性激素水平，目前主要是对7岁以上儿童血液中激素的研究，且研究样本量较小。目的　观察不同营养状况学龄前男童的尿Gn（UGn）、尿性激素水平，为无创性UGn和尿性激素的流行病学研究和临床应用提供参考依据。方法　2015年5月—2016年12月选取江苏省无锡市马山和胡埭社区学龄前男童（3岁≤年龄<7岁）为研究对象，测量其身高、体质量，计算其年龄别身高Z评分（HAZ）、年龄别体质量Z评分（WAZ）、体质指数（BMI）、年龄别体质指数Z评分（BAZ），并根据HAZ、WAZ、BAZ评分将其各分为6组。留取学龄前男童过夜晨尿，采用免疫化学发光法检测尿黄体生成素（ULH）、尿卵泡刺激素（UFSH）、尿雌三醇（UE3）、尿雌二醇（UE2）、尿睾酮（UT）。采用Kruskal-Wallis H检验进行多组间差异性比较，采用Kruskal-Wallis单因素方差分析进行多组间两两差异性比较，采用Spearman秩相关进行相关性分析。结果　符合本研究纳入标准并成功留尿的学龄前男童共871例，ULH、UFSH、UE3、UE2、UT的检出率分别为6.7%（58/871）、99.4%（866/871）、99.7%（868/871）、99.8%（869/871）、98.0%（854/871）。不同HAZ组间UE3比较，差异有统计学意义（P<0.05），其中He、Hf组均高于Hc组，He组高于Hd组（P<0.05）；各组UE2比较，差异有统计学意义（P<0.05），其中Hb组高于Ha、Hc、Hd组，He、Hf组高于Hc组（P<0.05）；各组UT比较，差异有统计学意义（P<0.05），其中He、Hf组均高于Hc组，He组高于Hd组（P<0.05）。不同WAZ组间UFSH比较，差异有统计学意义（P<0.05），其中Wf组高于Wc、Wd、We组（P<0.05）；各组UE3比较，差异有统计学意义（P<0.05），其中Wf组高于Wc、Wd、We组（P<0.05）；各组UE2比较，差异有统计学意义（P<0.05），其中Wc组低于Wb组，Wf组高于Wc、Wd、We组（P<0.05）；各组UT比较，差异有统计学意义（P<0.05），其中Wf组高于Wc、Wd、We组（P<0.05）。不同BAZ组间UFSH比较，差异有统计学意义（P<0.05），其中Bf组高于Bb、Bc、Bd组（P<0.05）；各组UE3比较，差异有统计学意义（P<0.05），其中Bd组低于Bb组，Bf组高于Bc、Bd、Be组（P<0.05）；各组UE2比较，差异有统计学意义（P<0.05），其中Bd组低于Bb组，Bf组高于Bc、Bd、Be组（P<0.05）；各组UT比较，差异有统计学意义（P<0.05），其中Bf组高于Bb、Bc、Bd、Be组（P<0.05）。相关性分析结果显示UFSH与身高（rs=0.095）呈正相关（P<0.05），UE3与HAZ（rs=0.106）、身高（rs=0.231）、WAZ（rs=0.082）、BAZ（rs=0.106）、BMI（rs=0.084）均呈正相关（P<0.05），UE2与HAZ（rs=0.081）、身高（rs=0.164）、BAZ（rs=0.081）均呈正相关（P<0.05），UT与HAZ（rs=0.102）、身高（rs=0.217）、WAZ（rs=0.074）、体质量（rs=0.070）、BAZ（rs=0.102）、BMI（rs=0.080）均呈正相关（P<0.05）。结论　学龄前男童尿液中ULH的含量较低，而其不同营养状况的UGn和尿性激素水平不同；随着短期营养状况的改善，其UE3、UE2、UT水平有升高的趋势；因此应该时刻关注学龄前男童的营养状况，保护学龄前男童的健康成长。

Relationship of Nutritional Status with Urine Gonadotropin and Sex Hormones in Preschool Boys

Background　Nutritional status may affect gonadotropin（Gn）and sex hormone levels in children.Currently，related studies mainly focus on the effect of nutritional status on the above hormones in blood of children over 7 years old，with relatively small sample sizes.Objective　To explore the levels of urine Gn and sex hormones in normal preschool boys with different nutritional status，providing a reference for epidemiological study and clinical application of urine Gn and sex hormones using non-invasive approaches.Methods　Preschool boys at least 3 years of age but less than 7 were selected from Mashan Street and Hudai communities，Jiangsu's Wuxi from May 2015 to December 2016.Height and weight were measured，and height-for-age Z-score（HAZ），weight-for-age Z-score（WAZ）and BMI-for-age Z-score（BAZ）were calculated.According to HAZ，WAZ and BAZ，they were divided into 6 groups，respectively.The first morning urine samples were collected.The urinary luteinizing hormone（ULH），urinary follicle-stimulating hormone（UFSH），urinary estriol （UE3），urinary estradiol（UE2），and urinary testosterone（UT）were determined by immunochemiluminometric assay.Kruskal-wallis H test was used to compare the differences among HAZ，WAZ and BAZ groups，respectively.Kruskal-wallis one-way ANOVA was conducted to compare the differences between HAZ，WAZ and BAZ groups，respectively.Spearman rank correlation was performed to analyze the correlations of urine Gn and sex hormones with HAZ，height，WAZ，weight，BAZ and BMI.Results　A total of 871 boys who met the inclusion criteria with successful urine specimen collection were included.The detection rates of ULH，UFSH，UE3，UE2 and UT were 6.7%（58/871），99.4%（866/871），99.7%（868/871），99.8%（869/871）and 98.0%（854/871），respectively.UE3 showed significant differences among HAZ groups（P<0.05），in particular，UE3 in Hc group was much lower than that of He and Hf groups，and UE3 in He group was much higher than that of Hd group（P<0.05）．UE2 differed significantly among HAZ groups（P<0.05），to be specific，UE2 in Hb group was much higher than that of Ha，Hc and Hd groups，and UE2 in Hc group was much lower than that of He and Hf groups（P<0.05）．UT varied significantly among HAZ groups（P<0.05），to be specific，UT in Hc group was much lower than that of He and Hf groups，and UT in Hd group was obviously lower than that of He group （P<0.05）．UFSH，UE3，UE2 and UT differed significantly among WAZ groups（P<0.05）．In particular，Wf group had much higher UFSH than Wc，Wd and We groups（P<0.05）；Wf group showed obviously higher UE3 than Wc，Wd and We groups（P<0.05）；Wc group had much lower UE2 than Wb group，and Wf group demonstrated significantly higher UE2 than Wc，Wd and We groups （P<0.05）；Wf group presented significantly higher UT than Wc，Wd and We groups（P<0.05）．UFSH，UE3，UE2 and UT varied significantly among BAZ groups（P<0.05）．Specifically，Bf group had much higher UFSH than Bb，Bc and Bd groups（P<0.05）；Bd group had much lower UE3 than Bb group，and Bf group showed obviously higher UE3 than Bc，Bd and Be groups （P<0.05）；Bd group had much lower UE2 than Bb group，and Bf group demonstrated much higher UE2 compared with Bc，Bd and Be groups （P<0.05）；Bf group demonstrated much higher UT compared with Bb，Bc，Bd and Be groups（P<0.05）．The correlation analysis showed that UFSH was positively correlated with height（rs=0.095，P<0.05）．UE3 was positively correlated with HAZ（rs=0.106），height（rs=0.231），WAZ（rs=0.082），BAZ（rs=0.106）and BMI（rs=0.084，P<0.05）．UE2 was positively correlated with HAZ（rs=0.081），height（rs=0.164）and BAZ（rs=0.081，P<0.05）．UT was positively correlated with HAZ（rs=0.102），height（rs=0.217），WAZ（rs=0.074），weight（rs=0.070），BAZ（rs=0.102） and BMI（rs=0.080，P<0.05）．Conclusion　In normal preschool boys，the ULH content is low，and urine Gn and sex hormones differ by nutritional status.UE3，UE2 and UT tend to be increased with the improvement of nutritional status in a short period of time.Therefore，the nutritional status in this population should be concerned in order to ensure their healthy growth.