超重和肥胖儿童并发性早熟的危险因素研究-东南大学学报医学版

超重和肥胖儿童并发性早熟的危险因素研究

作者：汤爱梅¹ 汤涌泉² 朱艳丽¹ 谷奇¹ 谭娟¹ 李月娥¹ 许媛媛² 王婕² 周文娣¹ 2

单位：1. 徐州医科大学淮安临床学院儿科, 江苏淮安 223300;
2. 南京医科大学附属淮安第一医院儿科, 江苏淮安 223300

分类号：R725.8

出版年·卷·期（页码）：2023·42·第二期（284-289）

摘要：

目的:通过对超重和肥胖并发性早熟儿童的临床特征和饮食及生活方式的分析,探讨超重和肥胖儿童并发性早熟的危险因素。方法:选取92例性早熟的超重、肥胖儿童为研究对象,测量体格生长指标,检测性激素水平和代谢指标,采用调查问卷询问父母喂养和养育方式及生活习惯等,以同期就诊于徐州医科大学淮安临床学院门诊的42例性发育正常的超重、肥胖儿童作为对照组。结果:(1) 超重、肥胖并发性早熟儿童体重指数(BMI)、BMI-标准差评分(SDS)、甘油三酯及总胆固醇较对照组低,而胰岛素样生长因子1(IGF-1)-SDS较对照组高,差异具有统计学意义(均P＜0.05);(2) 中枢性性早熟(CPP)组的2岁内进食豆制品、母乳喂养≤6月、开灯睡觉及母亲初潮≤13岁占比高于对照组,差异具有统计学意义(均P＜0.05);(3) 母乳喂养≤6月及母亲初潮≤13岁是超重、肥胖儿童并发性早熟的独立危险因素(P＜0.05)。结论:BMI、BMI-SDS、甘油三酯及总胆固醇与超重、肥胖儿童性早熟的发生并非正相关关系,改变婴幼儿的喂养和生活方式对预防超重、肥胖儿童并发性早熟有临床价值。

Objective: To explore the risk factors of precocious puberty in overweight and obese children through the analysis of clinical features, diet and lifestyle. Methods: A total of 92 overweight and obese children with precocious puberty were studied. Physical growth indexes, sex hormone levels and metabolic indexes were measured. The parents of overweight and obese children were asked about feeding and rearing style and living habits, and 42 overweight and obese children with normal sexual development were taken as control group. Results: (1) body mass index(BMI), BMI-standard deviation score(SDS), triglyceride and total cholesterol of overweight and obese children with precocious puberty were lower than those of the control group, the insulin-like growth factor 1(IGF-1)-SDS was higher than those of the control group,the differences were statistically significant(all P<0.05);(2) The proportions of eating soy products within 2 years, breast-feeding ≤6 months, sleeping with light on and menarche ≤13 years old in central precocious puberty(CPP) group were higher than those in control group, and the differences were statistically significant(all P<0.05);(3) Breast-feeding ≤6 months and menarche ≤13 years old were independent risk factors for premature puberty in overweight and obese children(P<0.05). Conclusion: BMI, BMI-SDS, triglyceride and total cholesterol are not positively correlated with the occurrence of precocious puberty in overweight and obese children. It is of clinical value to change infant feeding and life style to prevent precocious puberty in overweight and obese children.

参考文献：

[1] 马冠生.中国儿童肥胖报告[M].北京:人民卫生出版社,2017:5-27.
[2] PATTERSON R R,SORNALINGAM S,COOPER M.Consequences of covid-19 on the childhood obesity epidemic[J].BMJ,2021,373:n953.
[3] VERZANI M,BIZZARRI C,CHIOMA L,et al.Impact of COVID-19 pandemic lockdown on early onset of puberty:experience of an Italian tertiary center[J].Ital J Pediatr,2021,47(1):52.
[4] 许晓琴,章建伟,陈瑞敏,等.中国儿童体质指数与性发育水平的关系[J].中华儿科杂志,2022(4):311-316.
[5] LE MOAL J,ROGOU A,LE TERTRE A,et al.Marked geographic patterns in the incidence of idiopathic central precocious puberty:a nationwide study in France[J].Eur J Endocrinol,2018,178(1):33-41.
[6] 冯凡,曹卫平,白玲,等.镇江市城区4~10岁儿童性早熟发育的现状调查及其危险因素分析[J].中国儿童保健杂志,2018(6):651-653.
[7] 李辉,宗心南,季成叶,等.中国2~18岁儿童青少年超重和肥胖筛查体重指数界值点的研究[J].中华流行病学杂志,2010(6):616-620.
[8] 梁雁,杜敏联,罗小平.中枢性性早熟诊断与治疗共识(2015)[J].中华儿科杂志,2015,53(6):412-418.
[9] 王旭,李海浪.GH/IGF-1促生长轴与特发性中枢性性早熟的治疗[J].东南大学学报(医学版),2006(2):125-129.
[10] CHEN F R,ROTHMAN E F,JAFFEE S R.Early puberty,friendship group characteristics,and dating abuse in US girls[J].Pediatrics,2017,139(6):e20162847.
[11] ROA J,BARROSO A,RUIZ-PINO F,et al.Metabolic regulation of female puberty via hypothalamic AMPK-kisspeptin signaling[J].Proc Natl Acad Sci U S A,2018,115(45):e10758-e10767.
[12] FRANSSEN D,BARROSO A,RUIZ-PINO F,et al.AMP-activated protein kinase(AMPK) signaling in GnRH neurons links energy status and reproduction[J].Metabolism,2021,115:154460.
[13] VAZQUEZ M J,VELASCO I,TENA-SEMPERE M.Novel mechanisms for the metabolic control of puberty:implications for pubertal alterations in early-onset obesity and malnutrition[J].Endocrinol,2019,242(2):R51-R65.
[14] 肖文玉,付四毛,林翠兰,等.中枢性性早熟女童人体成分和血脂指标的相关性分析[J].中国妇幼保健,2022,37(19):3502-3506.
[15] 刘华,张梦莹,宋庆.晨血促黄体生成素联合胰岛素样生长因子1对儿童青春期启动的筛查效能[J].中国学校卫生,2022(9):1383-1387.
[16] FANG X,WANG L,WU C,et al.Sex hormones,gonadotropins,and sex hormone-binding globulin in infants fed breast milk,cow milk formula,or soy formula[J].Sci Rep,2017,7(1):4332.
[17] SEGOVIA-SIAPCO G,PRIBIS P,ODA K,et al.Soy isoflavone consumption and age at pubarche in adolescent males[J].Eur J Of Nutr,2018,57(6):2287-2294.
[18] FELICIO J S,DE ALCANTARA A L,JANAU L C,et al.Association of soy and exclusive breastfeeding with central precocious puberty:a case-control study[J].Front Endocrinol(Lausanne),2021,12:667029.
[19] KALE A,DEARDORFF J,LAHIFF M,et al.Breastfeeding versus formula-feeding and girls' pubertal development[J].Matern Child Health J,2015,19(3):519-527.
[20] 冯俊鹏,严翊.国内外儿童、青少年体力活动现状分析——基于2018年《全球儿童、青少年体力活动报告》[J].中国运动医学杂志,2019(12):1094-1100.
[21] PEINKHOFER M,BOSSINI B,PENCO A,et al.Reduction in pediatric growth hormone deficiency and increase in central precocious puberty diagnoses during COVID 19 pandemics[J].Ital J Pediatr,2022,48(1):49.
[22] SONG Y,MA J,WANG H J,et al.Trends of age at menarche and association with body mass index in Chinese school-aged girls,1985-2010[J].J Pediatr,2014,165(6):1172-1177.
[23] SHIM Y S,LEE H S,HWANG J S.Genetic factors in precocious puberty[J].Clin Exp Pediatr,2022,65(4):172-181.
[24] CANTON A,SERAPHIM C E,BRITO V N,et al.Pioneering studies on monogenic central precocious puberty[J].Arch Endocrinol Metab,2019,63(4):438-444.

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