性早熟女童硫化脱氢表雄酮和胰岛素水平的研究

Dehydroepiandrosterone sulfate and insulin in central precocious puberty girls.

目的探讨真性性早熟(CPP)女童肾上腺机能初现及是否具有肾上腺机能早现、高肾上腺雄激素血症、高胰岛素血症和胰岛素抵抗现象。方法以2006年8月1日至2007年8月1日舟山市妇幼保健院中符合纳入标准的CPP女童26例为研究对象,年龄(7.9±1.1)岁,以27例同期健康女童为对照组,年龄(7.8±1.3)岁。在隔夜空腹12h后,进行身体检查,并抽血检测空腹血糖、胰岛素、硫化脱氢表雄酮、皮质醇和雄烯二酮。胰岛素敏感性用胰岛素抵抗指数(HOMA-IR)评价。结果两组中均未发现肾上腺机能早现的临床表现。两组间体重指数、空腹血糖、皮质醇、硫化脱氢表雄酮、雄烯二酮和胰岛素抵抗指数差异无统计学意义。性早熟女童体重指数与胰岛素抵抗指数呈正相关(r=0.43,P<0.05)。性早熟合并超重或肥胖的女童血胰岛素水平、硫化脱氢表雄酮水平及胰岛素抵抗指数较正常对照组明显升高。结论真性性早熟女童未发现肾上腺机能早现、高肾上腺雄激素血症、高胰岛素血症和胰岛素抵抗现象。性早熟合并超重或肥胖的女童有胰岛素抵抗现象。

Objective To explore whether the association between central precocious puberty and increased risk of developing premature adrenarche, adrenal hyperandrogenism, hyperinsulinism and insulin resistance was apparent in 7 - 9 years old CPP girls. Methods The study was performed in 26 CPP girls with a mean age of 7.9 ± 1.1 years, and 27 healthy prepubertal girls with a mean age of 7.8 ± 1.3 years served as controls. Detailed physical examination was performed for all the children after 12 h of overnight fasting. Blood samples were taken for the measurement of fasting glucose （ FPG ） , insulin （ F Ins ） , dehydroepiandrosterone sulfate （ DHEAS ） , cortisol and androstenedione concentrations. Insulin sensitivity was assessed by HOMA-IR. HOMA-IR was defined as FINS（ mU/L ） × FPG（ mmol/L ）/22. 5. Results There was no premature adrenarche in two groups. Bodymass index （ BMI ）, fasting glucose, cortisol, DHEAS, androstenedione and HOMA-IR did not significantly differ between the two groups. Significant positive correlation was found between BMI and HOMA-IR in CPP girls （ r = 0.43, P 〈 0.05 ）. Among them, the level of Fins, DHEAS and HOMA-IR in four overweight and obese CPP girls was significantly higher compared with the control group. Conclusion There is no premature adrenarche, adrenal hyperandrogenism, hyperinsulinism and insulin resistance apparent in CPP girls. But insulin resistance is seen in CPP girls complicating with overweight and obesity.