目的 探究食欲素A(Orexin-A)对女童中枢性性早熟的影响.方法 选取2021年1月1日至2022年12月31日以来某妇幼保健院收治的特发性中枢性性早熟(idiopathic central precocious puberty,ICPP)女童30例为ICPP组,单纯性乳房发育女童30例为单纯性乳房早发育(premature thelarche,PT)组,健康女童30例为对照组.收集患儿资料.对ICPP组患儿进行治疗并随访,检测患儿治疗前后血清Orexin-A水平.评价Orexin-A在ICCP诊断中的价值.结果 ICPP组一般资料中身高、体重、骨龄、骨龄与年龄比值和阴毛发育评分,均高于PT组和对照组(P＜0.05);3组患儿的血清学指标中,ICPP组的Orexin-A低于其他两组,E2、LH、FSH、ORL显著高于PT组和对照组(P＜0.05).盆腔B超资料中,ICPP组的子宫容积、内膜厚度、卵巢容积、最大卵泡直径显著高于其他两组(P＜0.05).多因素分析显示,BMI、Orexin-A、子宫容积是女童ICPP的独立影响因素(P＜0.05).Orexin-A诊断ICPP的AUC为0.913,灵敏度为0.800,特异度为0.933.结论 ICPP女童的身体和第二性征提前发育,E2、LH、FSH和PRL激素水平上升,血清Orex-in-A水平下降,卵巢和子宫发育提前,同时Orexin-A在诊断ICPP方面有良好的参考价值,具有较高的灵敏度和特异度,可以为性早熟筛查提供帮助.
Effect of orexin-A on central precocious puberty in girls
Objective To explore the effect of Orexin-A on central precocious puberty in girls.Methods From January 1,2021 to December 31,2022,a total of 30 girls with idiopathic central precocious puberty(ICPP)were selected as ICPP group,30 girls with simple breast development as premature thelarche(PT)group,and 30 healthy girls as control group.We collected comprehensive clinical data from all participants.The children in ICPP group were treated and followed up,with serum orexin-A levels detected before and after treatment.We then evaluated the diagnostic value of Orexin-A for ICCP.Results The ICPP group demon-strated significantly higher values in height,weight,bone age,ratio of bone age to age and pubic hair develop-ment than those in PT and control groups(P＜0.05).Serum analysis revealed lower Orexin-A levels and higher estradiol(E2),luteinizing hormone(LH),follicle-stimulating hormone(FSH),and prolactin(PRL)levels in the ICPP group compared to the other two groups(P＜0.05).Pelvic B-ultrasound showed that the ICPP group had significantly larger uterine volume,thicker endometrium,larger ovarian volume and larger maximum follicle diameter than the other groups(P＜0.05).Multivariate analysis identified BMI,Orexin-A levels,and uterine volume as independent factors influencing ICPP in girls(P＜0.05).Orexin-A demonstra-ted good diagnostic performance for ICPP with an area under the curve(AUC)of 0.913,sensitivity of 0.800 and specificity of 0.933.Conclusion Girls with ICPP exhibit accelerated physical and secondary sexual char-acteristic development,elevated E2,LH,FSH and PRL hormone levels,decreased serum Orexin-A levels,and advanced ovarian and uterine development.Orexin-A has good reference value in the diagnosis of ICPP,demonstrating high sensitivity and specificity,which can provide help for precocious puberty screening.
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