| Part 1IntroductionPrecocious puberty(PP)and early puberty(EP)are called early onset puberty.Bone maturity is often evaluated by bone age(BA).PurposeTo investigate the characteristics of bone maturation in girls aged6 to 10 years with early onset pubety.MethodA total of 254 girls with early onset puberty were enrolled from the Department of Endocrinology,Shenzhen Children’s Hospital from December2018 to August 2019.BA was measured by artificial intelligence(AI)system.The girls were divided into groups according to their age,age of onset and course of disease,and the difference of BA and chronological age(CA)(BA-CA)and proportion of girls with significantly advanced BA((BA-CA ≥2 years)was described and analyz ed.Result1.A total of 254 girls with early onset puberty were included.The mean age of enrolled girls was 8.82±0.75 years old,the mean age of onset was8.04±0.88 years old,and the mean difference of BA and CA was 1.40±0.87 years old.The proportion of girls with significantly advanced BA was23.6%.2.The mean difference of BA and CA and proportion of significantly advanced BA of girls in 7,8 and 9 years old groups decreased in turn.There was statistical difference between girls in 9 and 7 years old groups,9 and 8 years old groups(P < 0.05),and no statistical difference between girls in 7 and 8 years old groups(P > 0.05).3.The mean difference of BA and CA and proportion of significantly advanced BA of girls in onset age of 6,7,8 and 9 years old groups decreased in turn.There was statistical difference between 9-year-old onset age group and other three groups(P < 0.05).There was statistical difference between the 8-year-old onset age group and the 6-year-old onset age group(all P < 0.05),but no statistical difference between the 7-year-old onset age group and the 8-year-old onset age group(P > 0.05).4.The mean difference of BA and CA and proportion of significantly advanced BA of girls in course <1 years,course 1～<2 years and course≥ 2 years groups increased in turn,but there was no statistical difference among them(P=0.154,P=0.073).5.(1)(1)In course <1 years group,the mean difference of BA and CA and proportion of significantly advanced BA of girls with onset age ≥8years old were significantly lower than those with onset age < 8 years old(all P < 0.05).(2)In course 1～<2 years group,the mean difference of BA and CA of girls with onset age ≥8 years old was significantly lower than that of girls with onset age < 8 years old(P=0.045),and proportion of significantly advanced BA of girls with onset age ≥8 years old was smaller than that of girls with onset age < 8 years old,but there was no statistical difference(P=0.069).(3)All the age of onset of girls in the course ≥2 years group was less than 8 years old.(2)Girls were divided into sub-groups according to the course and onset age.(1)In girls with course <1 years,the mean difference of BA and CA and proportion of significantly advanced BA of girls in groups of onset age of 6,7,8and 9 years old decreased in turn(all P < 0.05).The mean difference of BA and CA and proportion of significantly advanced BA of girls in onset age of 9 years old group were statistically different with the other three groups(all P <0.05).There was no statistical difference between the other groups(all P>0.05).(2)In girls with course 1～<2 years,the mean difference of BA and CA and proportion of significantly advanced BA of girls in groups of onset age of 6,7 and 8 years old decressed in turn.There were statically different between group of onset age of 6-year-old and group of onset age of 7-year-old and group of onset age of 8-year-old respectively(all P <0.05),and there was no statistically difference between groups of onset age of 7-year-old and 8-year-old(all P >0.05).(3)In girls with course ≥2 years,the mean difference of BA and CA and proportion of significantly advanced BA of girls in group of onset age of 7-year-old were lower than in group of onset age of 6-year-old,but there were no statistically difference(all P >0.05).Conclusion1.In girls with early onset puberty,the older they were,the less BA advancement was.The younger onset age,the more BA advancement.2.There was no significant difference in BA advancement between EP girls with early onset age and PP girls with late onset age.Part 2PurposeTo examined the association between 10 urinary metabolisms of PAEs(m PAEs)and bone maturation in girls with early onset puberty.Method254 girls collected in the first part of the study were subclassified into group A(bone age(BA)-chronological age(CA)≥2 years,n=61)and group B(BA – CA<2 years,n=194).Propensity score matching(PSM)were performed to reduce potentially biased estimate.Age of onset,duration of disease,BMI SDS,DHEAs SDS,and IGF-1 SDS were included as covariates for propensity score model.Group A and group B were match in 1:2 ratio and 93 girls were remained finally.Urinary m PAEs concentration difference between group A and group B was compared.The 93 girls were also divided into 3 groups according to tertiles of m PAE s concentrations: Low concentration group(lower tertile),medium concentration group(middle tertile)and high concentration group(upper tertile).Difference of BA-CA,and rate of significant BA advancement of girls between groups were analyzed.Result1.After matching,there was no statistical difference between group A and group B in all covariates(all P> 0.05),and the standardized mean difference of covariates was less than 0.1.2.Among the 93 girls,the highest concentration of urin ary m PAEs(creatinine-adjusted)was MBP with geometric mean of 203.77μg/g.It was followed by Mi BP(45.07μg/g),MEP(8.55μg/g),MMP(7.80μg/g),MECPP(7.17μg/g),MEHHP(5.99μg/g),MEHP(5.10μg/g),MEOHP(4.32μg/g),MCMHP(2.58μg/g)and MBz P(0.12μg/g)。LMW(308.41μg/g)was higher than HMW(28.05μg/g)。3.The urinary m PAEs levels were not statistically different between group A and group B,except for MEP.MEP concentrations of group A was significantly higher than group B(11.83ug/g VS.7.11 ug/g,P=0.031).4.In MEP groups,the BA advancement and proportions of girls with BA-CA ≥ 2 years in Low concentration group,medium concentration group and high concentration group increased in turn(1.32 years old,1.59 years old and 1.94 years old,respectively;16.2%,38.7% and 45.2%,respectively),and there were statistically different among the three groups(P=0.007,P=0.039).After the pairwise comparison,the BA advancement and proportions of girls with BA-CA ≥ 2 years in the high concentration group was significantly high er than the low concentration group(all P <0.05),while there was no statistical difference between the low concentration group and the middle concentration group,and the middle concentration group and the high concentration group(all P >0.05).ConclusionDEP/MEP may be involved in accelerating bone maturation in early pubertal girls. |
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