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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。
Objective To analyze the characteristics of glycolipid metabolism in girls with central precocious puberty (CPP) and the role of adiponectin in glucose and lipid metabolism in precocious girls. Methods Children’s Hospital of Zhejiang University School of Medicine from June to October 2004 were treated 50 cases of CPP girls, fasting blood glucose, insulin, triglycerides, cholesterol, adiponectin, and glucose tolerance test and insulin release test, using the overall insulin Sensitivity Index (WBISI), Insulin Resistance Index (HOMA-IR) of these two indicators to assess insulin sensitivity and pancreatic β-cell function. And compared with the age matched normal control group. Results (1) The fasting insulin and HOMA-IR in CPP girls were significantly higher than those in normal controls (P <0.01). (2) Cholesterol of CPP girl A1 group was significantly higher than that of the normal control group (P <0.05). (3) The body mass index (BMI) of CPP girls were significantly higher than that of the normal control group (P <0.05). Overweight 16% (8/50), obesity 8% (4/50). (4) CPP girls adiponectin were significantly lower than the normal control group (P <0.01). (5) There was a significant negative correlation between BMI and WBISI in girls with CPP (r = -0.31, P <0.05), positive correlation with HOMA-IR (r = 0.30, P <0.05) Significant negative correlation was found between the two groups (r = -0.43, P <0.01). There was a significant positive correlation between adiponectin and WBISI in CPP girls (r = 0.29, P <0.05). Multivariate regression analysis showed that there was no significant correlation between adiponectin and WBISI and HOMA-IR in CPP girls. (6) After excluding 12 cases of overweight plus obese CPP girls, analysis again showed that the fasting insulin and HOMA-IR of girls in A1 and A2 groups were still significantly higher than that of the normal control group (P <0.01), while the levels of adiponectin in the three groups were no difference Significance. Conclusion (1) CPP girls have different degrees of insulin resistance, especially in girls with precocious puberty. (2) Insulin resistance in obese or overweight precocious girls may be related to the decrease of adiponectin level.