青春期发育女童乳腺超声与卵巢、子宫超声及骨龄和性发育状况的关系

目的探讨青春期发育女童乳腺、卵巢、子宫超声及骨龄和性发育状况的关系。 方法回顾性分析为评价青春发育而就诊的女童110例，所有受试者均测量身高、体重、拍骨龄片、测性激素、行盆腔超声及乳腺超声检查，并根据乳腺超声分级和临床Tanner分期，分析与乳腺超声评级相关的生长发育参数，评估5个超声分级间参数的差异，进一步将Tanner Ⅱ期的女童按乳腺超声分为3个亚群，同样将乳腺超声B级的女童按Tanner分期分为3个亚群，比较亚群间相关参数的差异。 结果乳腺超声分级与年龄、骨龄、子宫体积、子宫长径及卵巢体积（左右卵巢的平均体积）均呈明显正相关，与体重指数（body mass index，BMI）、雌二醇(estradiol，E2)、促黄体生成素(luteinizing hormone，LH)存在一定相关性，与卵泡刺激素(follicle stimulating hormone，FSH)无明显相关性。受试女童110例按乳腺超声分为A级23例（20.9%）、B级46例（41.8%）、C级18例（16.4%）、D级5例（4.5%）、E级18例（16.4%）。C组、D组、E组年龄、骨龄、BMI、子宫体积、子宫长径和卵巢体积高于或大于A组和B组，E组、E2水平高于A组和B组，D组、E组LH水平高于A组和B组，差异有统计学意义（P＜0.05）。110例受试者中临床TannerⅡ期女童60例（54.5%），按乳腺超声分级，A级15例（25.0%）、B级38例（63.3%）、C级7例（11.7%）。3组间E2、子宫体积、子宫长径及卵巢体积差异均有统计学意义（P＜0.05），且随着超声分级的增加上述参数水平逐渐增加。而年龄、骨龄、LH、FSH、BMI差异无统计学意义（P＞0.05）。乳腺超声B级女童46例（41.8%），将B级女童按Tanner分期，Ⅰ期5例（10.9%）、Ⅱ期36例（78.2%）、Ⅲ期 5例（10.9%）。3组间年龄、E2、LH、FSH、BMI、子宫体积、子宫长径及卵巢体积差异均无统计学意义（P＞0.05），TannerⅢ期组骨龄大于TannerⅠ期组骨龄，差异有统计学意义（P＜0.05）。 结论乳腺超声分级与骨龄、子宫体积、子宫长径、卵巢体积存在明显正相关，对女童青春期乳房发育的评价更准确、更客观。

Relationship between breast ultrasound and ovarian,uterine ultrasound,bone age and sexual development in adolescent girls

ObjectiveTo investigate the relationship between breast, ovary, uterus ultrasound, bone age and sexual development in adolescent girls.MethodsA retrospective analysis of 110 cases of girls who were treated to evaluate puberty development was conducted. The height, weight, bone age film, sex hormone, pelvic ultrasound and breast ultrasound were performed. According to the breast ultrasound grading and clinical Tanner stage, the growth and development parameters related to breast ultrasound grading were analyzed, and the differences among the five ultrasonic grading parameters were evaluated The girls in stage Ⅱ were divided into three subgroups according to breast ultrasound, and the girls with grade B breast ultrasound were also divided into three subgroups according to Tanner stage.ResultsBreast ultrasound grading was positively correlated with age, bone age, uterine volume, uterine length and ovarian volume(mean volume of left and right ovaries), but not with FSH. According to breast ultrasound, 110 girls were divided into Grade A(20.9%), grade B 46(41.8%), grade C 18(16.4%), grade D 5(4.5%), and grade E 18(16.4%). The age, bone age, BMI, uterine volume, uterine length diameter and ovarian volume of group C, D and E were higher than or larger than those of group A and group B. the level of E2 in Group E was higher than that in group A and group B, and the level of LH in group D and E was higher than that in group A and group B(P＜0.05). Among the 110 subjects, 60(54.5%) were clinical Tanner stage Ⅱ girls. According to the breast ultrasound classification, 15 cases(25.0%) were grade A, 38 cases(63.3%) were grade B, and 7 cases(11.7%) were grade C. There were significant differences in E2, uterine volume, uterine length and ovarian volume among the three groups(P＜0.05), and the above parameters gradually increased with the increase of ultrasonic grading. There was no significant difference in age, bone age, LH, FSH and BMI(P＞0.05). According to Tanner stage, there were 5 cases(10.9%) in stage Ⅰ, 36 cases(78.2%) in stage Ⅱ and 5 cases(10.9%) in stage Ⅲ. There were no significant differences in age, E2, LH, FSH, BMI, uterine volume, uterine length diameter and ovarian volume among the three groups(P＞0.05). The bone age of Tanner stage Ⅲ group was greater than that of Tanner stage I group, and the difference was statistically significant(P＜0.05).ConclusionThere is a significant positive correlation between breast ultrasound grading and bone age, uterine volume, uterine length diameter, ovarian volume, which is more accurate and objective for the evaluation of puberty breast development of girls.