性发育异常新生儿的临床评价和管理

Clinical evaluation and management of neonates with disorder of sexual development

摘要:

性发育异常/性分化异常（DSD）是患儿染色体核型与性腺表型和（或）性腺的解剖结构不一致，表现为新生儿性别难辨。DSD主要根据染色体核型分为3类：46，XY DSD、46，XX DSD、性染色体DSD。临床上需要结合病史、体格检查、实验室和影像学检查来进行新生儿DSD的诊断、综合评估以及明确潜在的病因。性别认定必须在所有诊断评估完成后才能做出。医学社会多因素包括基因型性别（核型）、激素性性别（睾酮、双氢睾酮、肾上腺类固醇系列激素水平）、表现型性别（内外生殖器的外观）、生殖性别（生育的潜能）和父母的感觉乃至社会接受程度和宗教习俗等都会影响DSD患儿的性别认定。一个多学科合作的团队是必需的，患儿家人必须参与到有关性别认定的所有过程中。新生儿医师对于DSD 的主要任务在于评估患儿状况及其管理。

Abstract:

Disorder of sexual development or disorder of sex differentiation (DSD) refers to the inconsistency between karyotype and gonad phenotype and/or gonad anatomy in neonates and is manifested as the difficulty in identifying neonates' sex. According to the karyotype, DSD is classified as 46,XY DSD, 46,XX DSD, and sex chromosome DSD. A combination of detailed medical history, physical examination, and laboratory and imaging examinations is required for the diagnosis and comprehensive assessment of neonatal DSD and the determination of potential causes in clinical practice. Sex identification can only be made after all diagnostic evaluations have been completed. Sex identification of DSD neonates is influenced by various medical and social factors, including genotype (karyotype), sex hormones (levels of testosterone, dihydrotestosterone, and adrenal steroids), sex phenotype (appearance of internal and external genitals), reproduction (fertility potential), feelings of their parents, and even social acceptance and religious customs. A team with multidisciplinary cooperation is required, and patients must be involved in the whole process of sex identification. The major task of neonatal physicians for DSD is to assess the condition of neonates and provide management.