本文關(guān)鍵詞： 青春期 青春發(fā)動時相 抑郁癥狀 應(yīng)激反應(yīng)性 社會應(yīng)激　出處：《安徽醫(yī)科大學(xué)》2013年博士論文　論文類型：學(xué)位論文

【摘要】：目的建立中國城鄉(xiāng)有代表性兒童青少年青春期發(fā)育成熟事件的年齡、性別特征，提出中國人群青春期發(fā)育正常參考值和青春發(fā)育偏離的評價方法，探討青春發(fā)育偏離對心理健康的危害效應(yīng)及其可能的神經(jīng)生物學(xué)機制。 方法研究一、研究二的研究對象來自我國東北（遼寧沈陽）、華北（天津）、華東（上海、安徽合肥）、華中（湖北武漢、河南鄭州）、西南（重慶）、華南（廣東廣州）的城市和農(nóng)村地區(qū)，選取的學(xué)校以小班為單位進行整群抽樣，城鄉(xiāng)中小學(xué)每個年級（小學(xué)一年級～高中三年級）6.0～18.9歲漢族男女生為研究對象。開展體格發(fā)育指標（身高、體重）、青春期第二性征指標（女童乳房，男童外生殖器、睪丸容積，男女童陰毛）的客觀檢查，同時采用兒童抑郁問卷（Children Depression Inventory，CDI）評價抑郁癥狀。采用三種青春發(fā)動時相的評價方法：第二性征客觀評價法、青春發(fā)育量表（PDS）得分主觀評價法和自我感知主觀評價法，探討青春發(fā)育時相偏離與抑郁癥狀的關(guān)系。研究三選取安徽省蚌埠市某小學(xué)，開展體格發(fā)育、第二性征發(fā)育檢查以及抑郁癥狀等問卷調(diào)查。在1～3年級中選出56名第二性征客觀評價的青春發(fā)育提前女童，同時選取同齡（出生日期相差不超過2月）、相同BMI（相差不超過0.2kg/m2）、同班級、青春期發(fā)育適時的女童56人作為對照組。對兩組人群開展格羅寧根社會應(yīng)激實驗（Groningen SocialStress Test，GSST），并在社會應(yīng)激實驗前后，收集并檢測4次唾液皮質(zhì)醇水平，計算皮質(zhì)醇增高的曲線下面積（area under the curve with respect to the increase，AUCi）。 結(jié)果獲得我國8個協(xié)作地區(qū)城鄉(xiāng)30399名6.0～18.9歲兒童青少年青春期第二性征發(fā)育成熟事件的年齡、性別特征資料，其中男童15011人，女童15388人。男童外生殖器（11.24歲）和睪丸容積發(fā)育年齡（11.02歲）、女童乳房發(fā)育（9.18歲）和月經(jīng)初潮年齡（12.43歲）較早，，而我國男女童陰毛發(fā)育較遲（男：12.67歲；女：11.65歲）。肥胖男女童青春期發(fā)育顯著提前；城市男童青春期發(fā)育啟動顯著早于鄉(xiāng)村男童，而女童中這一城鄉(xiāng)差異無統(tǒng)計學(xué)顯著意義。 客觀與主觀評價的青春發(fā)育時相偏離對抑郁癥狀的影響結(jié)果不一致，PDS得分與同伴標化兩種主觀方法評價的青春發(fā)育提前與女童抑郁癥狀風(fēng)險的關(guān)聯(lián)更顯著。青春發(fā)育提前的男童抑郁癥狀顯著高于發(fā)育適時的同齡男童，且這一效應(yīng)在青少年早期表現(xiàn)的更加明顯。自我感知的青春發(fā)育提前和青春發(fā)育延遲均可顯著增加男女童抑郁癥狀的風(fēng)險。 青春發(fā)育提前的女童GSST結(jié)束即刻、GSST結(jié)束后20min以及皮質(zhì)醇AUCi均高于正常對照組女童。無論青春發(fā)育提前或正常對照組中，有抑郁癥狀的女童皮質(zhì)醇曲線下面積增長（AUCi）均低于無抑郁癥狀的女童。青春發(fā)育提前且無抑郁癥狀的女童皮質(zhì)醇AUCi最高，青春期發(fā)育正常、有抑郁癥狀的女童皮質(zhì)醇AUCi最低。 結(jié)論獲得的我國城鄉(xiāng)男女青春發(fā)動重要時間年齡值可作為現(xiàn)階段我國兒童青春發(fā)動時相評價標準。我國男女童青春期發(fā)育呈現(xiàn)出“啟動早、速度慢”的特點；自我感知的青春發(fā)育時相提前和延遲是男女童抑郁癥狀的危險因素；青春發(fā)育提前女童社會應(yīng)激下HPA軸應(yīng)激反應(yīng)性增高，可能是青春發(fā)育提前女童抑郁癥狀易感性升高的神經(jīng)生物學(xué)機制之一。
[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.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R179

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