特发性中枢性性早熟女童糖脂代谢指标、维生素D和性激素水平分析

Glucolipid metabolism,vitamin D and sex hormone levels in girls with idiopathic central precocious pu⁃berty

目的探究特发性中枢性性早熟女童糖脂代谢指标、维生素D与促性腺激素水平等指标,并研究上述指标的相关性。方法选取2017年1月至2020年4月本院收治的111例性早熟女童为研究对象,分为两组。一组为单纯性乳房早发育组,共51例;另一组为特发性中枢性性早熟组,共60例。检测所有研究对象的身高、体质量、第二性征,测定空腹血糖(FPG)、空腹胰岛素(FINS),甘油三酯(TG),胆固醇(CHO),胰岛素样生长因子⁃1(IGF⁃1)、25⁃羟维生素D3(25⁃(OH)D3)、促黄体生成素(LH)、促卵泡生成素(FSH)、LH峰值、FSH峰值等水平,并计算体质量指数(BMI)、胰岛素抵抗指数(HOME⁃IR)、LH峰值/FSH峰值,比较单纯性乳房早发育组和特发性中枢性性早熟组在糖脂代谢、维生素D及促性腺激素水平以及上述指标的相关分析。结果在特发性中枢性性早熟组中,BMI与LH、LH峰值/FSH峰值呈正相关(r=0.476、0.470,P<0.05),与维生素D呈负相关(r=-0.290,P<0.05)。IGF⁃1与LH、血脂、LH峰值、LH/FSH、胰岛素抵抗指数、BMI均呈正相关(r=0.553、0.355、0.351、0.459、0.531、0.330,P<0.05)。LH与胰岛素抵抗指数、BMI、IGF⁃1均呈正相关(r=0.320,0.476,0.553,P<0.05),与维生素D呈负相关(r值为-0.266,P<0.05)。胰岛素抵抗指数与LH、血脂、LH峰值/FSH峰值、IGF⁃1呈正相关(r=0.320、0.298、0.430、0.531,P<0.05)。51例单纯性乳房早发育女童中有39例女童维生素D水平不足,60例特发性中枢性性早熟女童中有46例女童维生素D不足。结论特发性中枢性性早熟女童糖脂代谢水平可能受性激素水平影响,而缺乏维生素D,BMI增加是女童性发育提前的重要因素。

Objective To analyze gonadotropin level,lipid metabolism,vitamin D and insulin resistance index of girls with idiopathic central precocious puberty,and analyze the correlation of these indexes with body mass.Methods A total of 111 cases of girls admitted to our hospital with precocious puberty were selected and divided into control group consisting of 51 patients with simple early breast development and observation group of 60 cases with idiopathic central precocious puberty.Height,weight,secondary sex characteristic,the determination of fasting plasma glucose(FPG),fasting insulin(FINS),triglyceride(TG),cholesterol(CHO),insulin⁃like growth factor 1(IGF⁃1),25⁃(OH)D3,luteinizing hormone(LH),follicle stimulating hormone(FSH),FSH peak level,LH peak level,and calculate the body mass index(BMI),insulin resistance index(HOME⁃IR),LH peak/FSH peak were tested and analyzed.The differences of gonadotropin level,lipid metabolism,vitamin D,HOME⁃IR between two groups were compared,and the correlation analysis of the above indexes was also conducted.Results In the observation group,BMI was positively correlated with LH,LH peak level/FSH peak level(r=0.476 and 0.470 respectively,P<0.05),and negatively with vitamin D(r=-0.290,P<0.05).IGF⁃1 was positively correlated with LH,TG,LH peak value,LH/FSH,IHOME⁃IR and BMI(r=0.553,0.355,0.351,0.459,0.531 and 0.330 respectively,P<0.05).LH was positively correlated with HOME⁃IR,BMI,IGF⁃1(r=0.320,0.476 and 0.553 respectively,P<0.05),and negatively with vitamin D(r=-0.266,P<0.05).HOME⁃IR was positively correlated with LH,TG,LH peak level/FSH peak level and IGF⁃1(r=0.320,0.298,0.430 and 0.531 respectively,P<0.05).Vitamin D deficiency was found in 39 of 51 girls in the control group and in 46 of 60 girls in the observation group.Conclusion Glucolipid metabolism in girls with idiopathic central precocious puberty may be affected by sex hormone levels.Vitamin D deficiency and increased BMI are important factors for girls in their early sexual development.