摘要
背景新冠病毒肺炎(COVID-19)疫情防控期间性早熟发病率迅速上升,推测这一现象与户外活动减少、屏幕时间延长、超重肥胖等有关,但具体机制不明。目的探讨褪黑素及25-羟维生素D与性早熟之间的相关性及预测价值,为性早熟的防治提供依据。设计病例对照研究。方法选取2022年3月至2023年10月郑州大学附属儿童医院临床诊断为中枢性性早熟的女童(CPP组)和单纯乳房早发育的女童(PT组),依据年龄匹配同期就诊的非性早熟健康女童作为对照组。比较组间血清褪黑素、25-羟维生素D的水平差异,分析褪黑素、25-羟维生素D及基础LH、LH峰值、LH峰/FSH峰、骨龄与实际年龄之差(BA-CA)等青春期发育指标之间的相关性,并评价褪黑素、25-羟维生素D对CPP的诊断效能,用中介效应模型验证褪黑素在25-羟维生素D与CPP之间的中介作用。主要结局指标不同血清褪黑素和25-羟维生素D水平对性早熟发生的影响。结果研究期间纳入CPP组61例,PT组40例,对照组61例。CPP组体质量指数(BMI)高于PT组和对照组,血清褪黑素和25-羟维生素D水平在CPP组、PT组和对照组间差异有统计学意义,且水平递增(H=62.534,P<0.001;H=16.213,P<0.001)。在维生素D和褪黑素水平均低的组别中CPP发病率高于仅维生素D缺乏组、仅褪黑素低水平组和两者水平均高组(χ2=42.262,P<0.001)。Spearman相关性分析显示褪黑素、25-羟维生素D水平与基础LH、LH峰值、LH峰/FSH峰、BA-CA等青春期发育指标呈负相关,而褪黑素与25-羟维生素D水平呈正相关,褪黑素和25-羟维生素D二者联合预测CPP的ROC曲线下面积为0.833(95%CI:0.771~0.895),优于单一指标,通过中介效应分析显示,褪黑素介导25-羟维生素D对CPP的影响,中介效应占总效应的54.1%。结论性早熟女童血清褪黑素和25-羟维生素D水平较正常女童偏低,维生素D缺乏可通过影响褪黑素分泌,进而参与性早熟尤其是CPP的发生。
Background The incidence of precocious puberty increased rapidly during the COVID-19 epidemic.It is speculated that this phenomenon is related to reduced outdoor activities,prolonged screen time,and overweight and obesity,but the spe-cific mechanism remains unclea.Objective To explore the correlation and predictive value between melatonin and 25-hydroxyvitamin D and precocious puberty,and to provide a basis for the prevention and treatment of precocious puberty.Design Case-control study.Methods From March 2022 to October 2023,girls diagnosed with central precocious puberty(CPP group)and girls diagnosed with premature breast development(PT group)in Children′s Hospital Affiliated to Zhengzhou University were selected.Agematched healthy girls without precocious puberty who visited the hospital during the same period were selected as the control group(NC group).The serum levels of melatonin and 25-hydroxyvitamin D were compared among the three groups,and their relation-ships with basic LH,LH peak,LH/FSH peak,BA-CA and other pubertal development indicators were analyzed.And evaluate the diagnostic efficacy of melatonin and 25-hydroxyvitamin D for CPP.Use the mediation effect model to verify the mediating role of melatonin between 25-hydroxyvitamin D and CPP.Use the mediation effect model to verify the mediating role of melatonin between 25-hydroxyvitamin D and CPP.Main outcome measures The influence of different serum levels of melatonin and 25-hydroxyvitamin D on the occurrence of precocious puberty.Results A total of 61 patients in CPP group,40 patients in PT group and 61 patients in NC group were included.The body mass index(BMI)of the CPP group was higher than that of the PT group and the control group.There were statistically significant differences in serum melatonin and 25-hydroxyvitamin D levels among the CPP group,the PT group and the control group,and the levels increased progressively(H=62.534,P<0.001;H=16.213,P<0.001).Among the groups where both levels were low,the prevalence of CPP was higher than that in the group with only vitamin D deficiency,the group with only low levels of melatonin,and the group with both high levels of both substances(χ2=42.262,P<0.001).Spearman correlation analysis showed that the levels of melatonin and 25-hydroxyvitamin D were negatively correlated with basic LH,LH peak,LH peak/FSH peak,BA-CA and other puberty development indicators,while there was a positive correlation between the levels of melatonin and 25-hydroxyvitamin D.The area under the ROC curve for the combined prediction of CPP by melatonin and 25-hydroxyvitamin D was 0.833(95%CI:0.771,0.895),which was superior to that of a single indicator.Through mediation effect analysis,it was shown that melatonin mediated the effect of 25-hydroxyvitamin D on CPP,with the mediation effect accounting for 54.1%of the total effect.Conclusion The levels of serum melatonin and 25-hydroxyvitamin D in girls with precocious puberty are lower than those in normal girls.The serum melatonin and 25-hydroxyvitamin D levels of precocious puberty girls are lower than those of normal girls.Vitamin D deficiency can affect melatonin secretion and thereby participate in the occurrence of precocious puberty,especially CPP.
作者
魏怡
袁淑娴
林一凡
赵艺璇
刘晓景
马晓翠
卫海燕
WEI Yi;YUAN Shuxian;LIN Yifan;ZHAO Yixuan;LIU Xiaojing;MA Xiaocui;WEI Haiyan(Department of Endocrinology and Inherited Metabolic,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China;Henan Key Laboratory of Pediatric Genetic and Metabolic Diseases,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China;Tianjian Laboratory of Advanced Biomedical Sciences,Academy of Medical Sciences,Zhengzhou University,Zhengzhou 450001,China)
出处
《中国循证儿科杂志》
北大核心
2025年第5期348-354,共7页
Chinese Journal of Evidence Based Pediatrics
基金
国家科技部项目:2021YFC2701900
河南省科技厅科技攻关项目:232102310088
河南省医学科技项目:LHGJ20250617。
作者简介
共同第一作者:魏怡;共同第一作者:袁淑娴;通信作者:卫海燕,email:haiyanwei2009@163.com。
