中枢性性早熟和快进展型早发育女孩GnRHa治疗前后体脂和代谢的改变

Changes of Body Fat and Metabolic Parameters during GnRHa treatment in Central Precocious Puberty or Early and Fast Puberty Girls

目的观察中枢性性早熟(CPP)或快进展型早发育(EFP)女孩用促性腺激素释放激素类似物(GnRHa)治疗后体脂和血脂、血糖代谢的改变。方法根据女孩8岁前是否出现第二性征发育,分别诊断CPP和EFP,两者接受同样的检查和治疗。前瞻性追踪研究41例(CPP 25例,EFP 16例)接受GnRHa治疗的女童,比较其GnRHa治疗开始时、治疗6个月及12个月末的体块指数(BMI)、体脂物理参数、血脂、糖代谢及相关脂肪因子(瘦素、脂联素)的改变。结果治疗开始时、6个月、12个月,BMI分别为(16.7±2.1)、(17.0±1.9)、(17.9±2.1)kg/m^2,瘦素分别为(5.1±3.6)、(6.4±3.8)、(11.3±6.7)ng/m L,脂联素分别为(84.3±20.2)、(110.9±34.4)、(95.6±35.0)g/m L,3个时间点间的总体差异(one-way ANOVA)有统计学意义(P<0.05)。GnRHa治疗6个月末,BMI、瘦素及脂联素均较治疗开始时显著增加。GnRHa治疗12个月末,最小皮下脂肪较治疗开始时显著增加,腹壁脂肪指数(AFI)较前显著下降;BMI、体块指数标准差分数(BMISDS)、瘦素、胰岛素[(10.7±5.6)U/L vs(8.4±4.1)U/L,(8.8±3.5)U/L)均较治疗开始时和治疗6个月末显著增加。空腹血糖、胰岛素抵抗指数(HOMA-IR)和血脂在3个时点均无显著改变。结论 CPP及EFP应用GnRHa治疗时,虽然性腺轴受抑,雌二醇下降,但青春期同时升高的瘦素却并不伴随回落,同时体脂增加,胰岛素升高,这可能与对代谢有正性影响的雌激素撤退和对代谢有负性影响的瘦素持续增高有关。

[ Objective ] To observe the changes of body fat and metabolic parameters of central precocious puberty （CPP） or early and fast puberty （EFP） girls who were treated with Gonadotropin-releasing hormone analogs （GnRHa）. [Methods] According to whether the secondary sex characters begin to appear before or after 8 years, patients were divided into CPP and EFP group. Both groups accept the same examinations and treatments. Forty-one girls （25 CPP and 16 EFP） , who were treated with GnRHa for one year, were enrolled in our perspective study. BMI, body fat parameters, serum lipid, fast blood glucose, insulin and adipokine （lepin, adiponectin） were obtained before treatment, after 6 months and 12 months of treatment. [ Results ] BMI were （16.7 ± 2.1 ） kg/m^2, （17.0 ± 1.9）kg/m^2, （17.9 ± 2.1）kg/m^2; leptin were （5.1 ±3.6）ng/mL, （6.4 ± 3.8）ng/mL, （11.3± 6.7）ng/mL; adiponectin were （84.3 ± 20.2）g/mL, （110.9 ± 34.4）g/mL, （95.6 ± 35.0）g/mL at beginning, 6 months and 12 months respectively. There were significant differences in the overall comparison of the three time points by one-way ANOVA. BMI, lepin and adiponectin were significantly elevated after 6 months of treatment compare to beginning. After 12 months of treatment, the minimal thickness of the subcutaneous fat, BMI, BMISDS, lepin and insulin [ （10.7 ± 5.6）U/L vs （8.4 ± 4.1）U/L, （8.8 ± 3.5）U/L] were significantly elevated compared to beginning and 6 months. Fast blood glucose, HOMA-IR, Chol, TG, HDL and LDL didn＇t change significantly after 6 or 12 months of treatment. [Conclusion]During GnRHa treatment, gonadal axis were depressed and estrogen decrease. However, elevated leptin level will not decrease along with estrogen. At the same time, body fat were accumulated and insulin were elevated. It probably due to the withdrawal of estrogen, which had positive regulation effect to the metabolism, and the rising of lepin, which had negative effect to metabolism.