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目的分析中枢性性早熟(CPP)女童糖脂代谢的特点及脂联素在性早熟女童糖、脂代谢中的作用。方法浙江大学医学院附属儿童医院于2004年6~10月收治50例CPP女童,测量空腹血糖、胰岛素、甘油三酯、胆固醇、脂联素,并做葡萄糖耐量试验和胰岛素释放试验,采用总体胰岛素敏感指数(WBISI)、胰岛素抵抗指数(HOMA-IR)这2个指标来评估胰岛素敏感性和胰岛β细胞功能。并与年龄匹配的正常对照组进行比较。结果(1)CPP女童空腹胰岛素、HOMA-IR明显高于正常对照组(P<0·01)。(2)CPP女童A1组胆固醇较正常对照组明显升高(P<0·05)。(3)CPP女童体重指数(BMI)值均较正常对照组明显升高(P<0·05)。其中超重16%(8/50),肥胖8%(4/50)。(4)CPP女童脂联素均较正常对照组明显下降(P<0·01)。(5)CPP女童BMI值与WBISI显著负相关(r=-0·31,P<0·05),与HOMA-IR显著正相关(r=0·30,P<0·05),与脂联素显著负相关(r=-0·43,P<0·01)。CPP女童脂联素与WBISI显著正相关(r=0·29,P<0·05),多元回归分析显示CPP女童脂联素与WBISI、HOMA-IR无显著相关性。(6)排除12例超重加肥胖CPP女童后再分析显示A1、A2组女童空腹胰岛素、HOMA-IR仍明显高于正常对照组(P<0·01),而脂联素水平3组差异无显著性。结论(1)CPP女童存在不同程度的胰岛素抵抗,尤见于BMI值明显升高的性早熟女童。(2)肥胖或超重的性早熟女童胰岛素抵抗可能与脂联素水平下降有关。

Study of glucose and lipid metabolism in girls with precocious puberty and the relationship with adiponectin

?? AbstractObjectiveTo analyze the change of glucose and lipid metabolism in girls with precocious puberty and the relationship with adiponectin. MethodsFrom Jun. to Oct. 2004,a total of 50 central precocious puberty girls aged from 6 to 9 years were evaluated in this study in the Affiliated Children's Hospital of Medical College of Zhejiang University.(groupA1,Tanner??,n=31,7.9??0.9 years;groupA2,Tanner??,n=19,8.3??1.0 years).Biochemical indicators,included fasting glucose,fasting insulin,TG and cholesterol,were measured.Oral glucose (1.75g/kg,no more than 75g) tolerance test (OGTT) was also done and serum glucose and insulin were measured in 0 min,30 min,1 h,2 h and 3 h.The levels of serum fasting adiponectin was measured by ELISA method.Insulin sensitivity was estimated by WBISI and HOMA??IR.Thirty??four prepuberty girls were set as controls. Results1)The level of FINS and HOMA??IR increased in CPP girls,as compared with the control group (P<0.01).2) The level of cholesterol in groupA1 was significantly higher than in control children.However,cholesterol in groupA2 and TG in CPP girls showed no significant difference from the control group.3)Body mass index(BMI) in CPP girls was significantly higher than in the control group (P<0.05).Among these 50 CPP girls,8 of them were overweight and 4 of them were obese children.4) Adiponectin in CPP girls was significantly lower than in the control group(P<0.01).5) There was a significant negative correlation between BMI and WBSIS in CPP girls(r=-0.31,P<0.05),and a significant positive correlation was found between BMI and HOMA??IR(r=0.30,P<0.05).Furthermore,a significant negative correlation between BMI and adiponectin was found in CPP girls(r=-0.43,P<0.01).The adiponectin level showed significant positive correlation with WBISI(r=0.29,P<0.05),but there was no significant correlation between adiponectin and WBISI in multiple regression analysis.6)Except 12 overweight and obese CPP girls,the level of FINS and HOMA??IR also increased in CPP girls,but the level of adiponectin showed no significant difference. Conclusion(1)The findings of this study indicate that insulin resistance might be involved in CPP girls,especially in girls with high BMI.(2) Decrease of adiponectin might be partly responsible for the insulin resistance in overweight or obese CPP girls.