中国儿童青春发动时相评定标准的建立及应用研究

发布时间：2018-01-19 15:11

本文关键词： 青春期青春发动时相抑郁症状应激反应性社会应激　出处：《安徽医科大学》2013年博士论文　论文类型：学位论文

【摘要】：目的建立中国城乡有代表性儿童青少年青春期发育成熟事件的年龄、性别特征，提出中国人群青春期发育正常参考值和青春发育偏离的评价方法，探讨青春发育偏离对心理健康的危害效应及其可能的神经生物学机制。方法研究一、研究二的研究对象来自我国东北（辽宁沈阳）、华北（天津）、华东（上海、安徽合肥）、华中（湖北武汉、河南郑州）、西南（重庆）、华南（广东广州）的城市和农村地区，选取的学校以小班为单位进行整群抽样，城乡中小学每个年级（小学一年级～高中三年级）6.0～18.9岁汉族男女生为研究对象。开展体格发育指标（身高、体重）、青春期第二性征指标（女童乳房，男童外生殖器、睾丸容积，男女童阴毛）的客观检查，同时采用儿童抑郁问卷（Children Depression Inventory，CDI）评价抑郁症状。采用三种青春发动时相的评价方法：第二性征客观评价法、青春发育量表（PDS）得分主观评价法和自我感知主观评价法，探讨青春发育时相偏离与抑郁症状的关系。研究三选取安徽省蚌埠市某小学，开展体格发育、第二性征发育检查以及抑郁症状等问卷调查。在1～3年级中选出56名第二性征客观评价的青春发育提前女童，同时选取同龄（出生日期相差不超过2月）、相同BMI（相差不超过0.2kg/m2）、同班级、青春期发育适时的女童56人作为对照组。对两组人群开展格罗宁根社会应激实验（Groningen SocialStress Test，GSST），并在社会应激实验前后，收集并检测4次唾液皮质醇水平，计算皮质醇增高的曲线下面积（area under the curve with respect to the increase，AUCi）。结果获得我国8个协作地区城乡30399名6.0～18.9岁儿童青少年青春期第二性征发育成熟事件的年龄、性别特征资料，其中男童15011人，女童15388人。男童外生殖器（11.24岁）和睾丸容积发育年龄（11.02岁）、女童乳房发育（9.18岁）和月经初潮年龄（12.43岁）较早，，而我国男女童阴毛发育较迟（男：12.67岁；女：11.65岁）。肥胖男女童青春期发育显著提前；城市男童青春期发育启动显著早于乡村男童，而女童中这一城乡差异无统计学显著意义。客观与主观评价的青春发育时相偏离对抑郁症状的影响结果不一致，PDS得分与同伴标化两种主观方法评价的青春发育提前与女童抑郁症状风险的关联更显著。青春发育提前的男童抑郁症状显著高于发育适时的同龄男童，且这一效应在青少年早期表现的更加明显。自我感知的青春发育提前和青春发育延迟均可显著增加男女童抑郁症状的风险。青春发育提前的女童GSST结束即刻、GSST结束后20min以及皮质醇AUCi均高于正常对照组女童。无论青春发育提前或正常对照组中，有抑郁症状的女童皮质醇曲线下面积增长（AUCi）均低于无抑郁症状的女童。青春发育提前且无抑郁症状的女童皮质醇AUCi最高，青春期发育正常、有抑郁症状的女童皮质醇AUCi最低。结论获得的我国城乡男女青春发动重要时间年龄值可作为现阶段我国儿童青春发动时相评价标准。我国男女童青春期发育呈现出“启动早、速度慢”的特点；自我感知的青春发育时相提前和延迟是男女童抑郁症状的危险因素；青春发育提前女童社会应激下HPA轴应激反应性增高，可能是青春发育提前女童抑郁症状易感性升高的神经生物学机制之一。
[Abstract]:Objective to establish urban and rural Chinese representative adolescent pubertal maturation event age, gender characteristics, the Chinese crowd puberty normal reference value evaluation method and the deviation of youth development, youth development from the effects of mental health and its possible neurobiological mechanisms.
A study of two research methods, the research object from Northeast China (Liaoning, Shenyang), North China (Tianjin), East China (Shanghai, Anhui, Hefei), China (Hubei Wuhan, Henan Zhengzhou), Southwest (Chongqing), Southern China (Guangdong, Guangzhou) of the city and rural areas, schools selected by cluster sampling in class as a unit, each middle school grade (primary school the first grade to the third grade of senior high school) 6 ~ 18.9 years old male and female students as the research object. To carry out the physical development index (height, weight), pubertal index (female breast, boy genitalia, testicular volume, and Tong Yinmao) the objective examination, at the same time the children's Depression Questionnaire (Children Depression Inventory, CDI) to evaluate the depressive symptoms. Using three kinds of pubertal timing assessment methods: secondary sexual characteristics and objective evaluation method, the youth development scale (PDS) score of subjective evaluation method and self perception of subjective evaluation, Discussion on youth development are deviated from relationship with depressive symptoms. In study three, a primary school in Anhui city of Bengbu Province, to carry out the investigation of physical development, the development of secondary sexual characteristics and check depression questionnaire. Selected 56 secondary sexual characteristics evaluation of the early puberty girls in the 1 to 3 grade, and age-matched (born the date is not more than the same BMI (February), but no more than 0.2kg/m2), the same class, puberty girls timely 56 people as control group. Groningen to carry out the social stress experiment of two groups (Groningen, SocialStress, Test, GSST) before and after the social stress test, collect and test 4 salivary cortisol level, calculation the area under the curve of increased cortisol (area under the curve with respect to the increase, AUCi).
The results of our 8 collaboration between urban and rural area 30399 6 ~ 18.9 years old children and adolescents of pubertal maturation events for age gender characteristics, which, 15011 boys, 15388 girls. Boys' genitalia (11.24 years old) and testicular volume developmental age (11.02 years old), breast development girls (9.18 years old) and the age of menarche (12.43 years old) earlier, and our male and female pubic hair development later (male: 12.67; female: 11.65 years old). Boys and girls in puberty obesity significantly ahead of time; city boys puberty start earlier than rural boy, and had no statistical significance of the difference between urban and rural girls.
The objective and subjective evaluation of the youth development phase deviation effect on depressive symptoms of inconsistent results, PDS score and peer standardized evaluation of two kinds of subjective methods of puberty associated with girls early depressive symptoms were more significant. Boys' risk of depressive symptoms was significantly higher in early puberty development timely age boys, and the effect in the early teens were more obvious. The self perceived early puberty and developmental delay significantly increased risk of depressive symptoms for boys and girls.
Early puberty girls at the end of GSST, GSST after 20min and cortisol AUCi were higher than the normal control group. Both girls early puberty or in normal control group, growth in the area of girls had symptoms of depression by cortisol curves (AUCi) were lower than those without depression. Early puberty girls and girls cortisol without depressive symptoms the highest AUCi, normal puberty, girls have symptoms of depression cortisol AUCi is the lowest.
The conclusion obtained in China's urban and rural youth men and women launched a major time age value can be regarded as at the present stage of China's children's pubertal timing evaluation standard. Our boys and girls in puberty presents "start early, slow speed characteristics"; self perceived youth development phase advance and delay are the risk factors of children's depressive symptoms; early puberty girls social stress HPA axis stress increased, may be one of the neurobiological mechanisms of early puberty girls increased depression susceptibility.

【学位授予单位】：安徽医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R179

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