儿童和青少年血清硫酸脱氢表雄酮的变化规律

目的 了解儿童和青少年血清硫酸脱氢表雄酮(DHEAS)随性别、年龄和青春发育变化的规律并探讨肾上腺功能发动和青春发育之间的关系.方法 分别测定318名健康儿童和青少年(男童120名,女童198名)和152例特发性中枢性性早熟(ICPP)女童血清DHEAS,按性别、年龄、青春发育分期进行统计分析.结果 6岁以下的健康儿童和ICPP女童血清DHEAS均极低下,且与性别、年龄、青春发育分期均不相关.健康儿童血清DHEAS水平在两性均与年龄和青春发育呈正相关(r分别为0.69和0.71,P均＜0.01).青春期后,男童血清DHEAS水平显著高于相同青春分期女童(P均＜0.05).同性别健康青春期青少年,相同年龄段内,血清DHEAS水平随青春发育而增高;而相同青春发育期内则不随年龄变化,如TannerⅢ期女童在8～9岁、10～11岁和12～13岁3个年龄段,血清DHEAS均数在532.0～557.8 μg/L(F=0.21,P=0.98).6岁以上ICPP女童血清DHEAS的Z分值显著高于同年龄的健康女童组(0.97us-0.1和1.39us-0.08,P均≤0.01),而与相同青春发育分期的健康女童间差异无统计学意义(-0.31～0.18us0.00,P均＞0.05).结论 血清DHEAS在6岁以后随年龄和青春发育的进展而增高,两性差别在青春发育后方显现.肾上腺功能发动和性腺功能发动间具相互联系.在青春发育后应同时结合性别、年龄和青春发育分期判断血清DHEAS.

Change of serum dehydroepiandrosterone sulfate (DHEAS) level in children and adolescents

Objective To understand how serum DHEAS levels change with sex,age and stage of sexual maturation in children and adolescents and explore the relationship between adrenarche and pubertal maturatiotL Methods Serum samples from 120 healthy boys,198 healthy girls and 152 girls with idiopathic central precocious puberty (ICPP) were examined for DHEAS.Referenee ranges for healthy children and adolescents and statistical difierences between heahhy girls and ICPP girls were analyzed with respect to sex,age and stage of sexual maturation.Results Both healthy children and ICPP girls showed extremely low levels of serum DHEAS and they were not related to sex.age or tanner stages in the individuals below age of 6 years.Serum DHEAS levels were positively related to both age (above age of 6 years)and tanner stage in healthy groups(r=0.69 and 0.71 respectively,P＜0.01).After the onset of puberty,serum DHEAS levels appeared to be higher in boys than that in girls within the same tanner stage(P＜0.05).Within the individusis in the same age group with same sex.serum DHEAS levels increased along with pubertal development.While within the individuals in same tanner stage group with salne sex after puberty onset.serum DHEAS levels showed no significant difference among different age groups.For example.there was no difference in serum DHEAS levels of healthy girls in tanner stage Ⅲ among different age subgroups(age of8-9;age of 10-11,age of 12-13)and the mean vallie of serum DHEAS was 532.0-557.8μg/L(F=0.21,P=0.98).In different age subgroups above age of 6 years,Z scores for serum DHEAS in ICPP girls were highher than them healthy ones with advanced tanner stages(0.97us-0.1 and 1.39us-0.08,JP≤0.01)In different tanner stage subgroups.Z scores for serum DHEAS showed no difierence between healthy and ICPP girls despite apparent different age ranges(0.00 us-0.31-0.18,P＞0.05).Conclusions Serum DHEAS level increased along with both age (above 6 years) and tanner stage in healthy children and adolescents.There was no gender difference until the onset of puberty.It was demonstrated that adrenache and gonadarche were related to each other.Reference ranges for adolescents should be interpreted according to sex.age and tanner stage simultaneously.