特发性中枢性性早熟女童血浆kisspeptin、神经激肽B及强啡肽浓度的变化研究

目的 研究特发性中枢性性早熟(ICPP)女童血浆kisspeptin,神经激肽B(NKB)及强啡肽浓度的变化,探索其在ICPP发病中的作用。方法 选取2016年1月-2017年1月在山东大学齐鲁医院确诊为ICPP并未经治疗的女童50例,观察并比较ICPP女童与正常健康女童以及ICPP女童治疗前后性发育状况和血浆kisspeptin、神经激肽B、强啡肽浓度的变化。结果 未行治疗的ICPP女童的骨龄、骨龄/年龄、身高标准差单位(SDS)、黄体生成素基础值(B-LH)、卵泡刺激素基础值(B-FSH)、雌二醇(E2)、kisspeptin、NKB与健康对照组相比差异均有统计学意义(P<0.01),治疗6个月后,其B-LH、黄体生成素峰值(P-LH)、B-FSH、卵泡刺激素峰值(P-FSH)、P-LH/P-FSH、E2、kisspeptin、NKB较治疗之前均显著下降(P<0.01),治疗12个月后上述指标与治疗6个月时差异无统计学意义(P>0.05),强啡肽在各组之间差异无统计学意义(P>0.05)。ICPP女童接受促性腺激素释放激素类似物(GnRHa)治疗后,其性发育在3个月之内均得到明显控制,持续观察至12月,性发育均未再明显进展。Kisspeptin和NKB、P-LH、P-LH/P-FSH、E2均存在明显正相关关系(P<0.05),NKB和kisspeptin、P-LH、P-LH/P-FSH、E2也存在明显正相关关系(P<0.05)。结论 Kisspeptin和NKB在ICPP的发病过程中起重要作用,其有可能成为监测儿童性发育及评价ICPP治疗效果的有效指标。

Research on the change of plasma concentrations of kisspeptin,neurokinin B and dynorphin in girls with idiopathic central precocious puberty

Objective To investigate the change of plasma concentrations of kisspeptin,neurokinin B(NKB) and dynorphin(Dyn) in girls with idiopathic central precocious puberty(ICPP). Methods Totally 50 girls with ICPP before treatment were enrolled in this study from January 2016 to January 2017 in Qilu hospital, shandong University. The changes of sexual development situation and plasma kisspeptin,NKB and dynorphin concentrations between girls with ICPP and normal healthy girls before and after treatment were analyzed. Results There were significant differences on bone age,bone age/age of child,standard deviation score of height(SDS),basal luteinizing hormone(B-LH),basal follicle stimulating hormone(B-FSH),estradiol(E2),kisspeptin and NKB between ICPP group and healthy control group before treatment(P<0.01). After 6 months treatment,the levels of B-LH,peaking LH(P-LH),B-FSH,peaking FSH(P-FSH),P-LH/ P-FSH,E2,kisspeptin and NKB significantly decreased compared with those before treatment(P<0.01). However,difference on the above indexes were not found significant between 6 months and 12 months after treatment in ICPP girls(P>0.05),and there was no significant difference on the level of Dyn among threee groups(P>0.05). After treatment with gonadotropin releasing hormone analogue(GnRHa),the sexual development of ICPP girls was significantly controlled within 3 months,and the sexual development did not significantly improved at the end of 12 months. Moreover,kisspeptin level was positively correlated with NKB,P-LH,P-LH/P-FSH and E2(P<0.05),and NKB level was also positively correlated with kisspeptin,P-LH,P-LH/P-FSH and E2,too(P<0.05). Conclusion Kisspeptin and NKB play an important role in the pathogenesis of ICPP,and may become an effective indicator for monitoring children'sexual development and evaluating therapeutic effect of ICPP children.