早初潮及GnRHa治疗女孩初潮后代谢和性腺轴的改变  

Metabolism and Axis of Early Menarche Girls and Girls Treated with GnRHa

作　　者：陈秋莉[1] 张军[1] 李燕虹[1] 郭松[1] 马华梅[1] 杜敏联[1] 陈红珊[1] 古玉芬[1] 

机构地区：[1]中山大学附属第一医院儿科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2017年第3期412-417,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(A2015303)

摘　　要：【目的】探讨早初潮女孩及应用过促性腺激素释放激素类似物(GnRHa)治疗的女孩代谢和性腺轴的改变。【方法】选取我院因早初潮就诊39例,曾应用GnRHa治疗并已呈现初潮女孩58例作为研究对象,并以正常初潮19例作为对照。测量身高、体重,B超测量子宫、卵巢大小,抽血查性激素及胰岛素、血糖、血脂、leptin、adiponectin等代谢指标。【结果】早初潮女孩年龄别和骨龄别体质指数标准差分值(BMISDS)均较正常初潮女孩显著增高(P<0.05),发生胰岛素抵抗的比例(20.5%)亦较正常初潮女孩(0%)显著升高,而脂代谢和性腺轴各项指标均无差异。GnRHa治疗者初潮后BMISDS和胰岛素、HOMA-IR及发生胰岛素的比例(20.7%)均较正常初潮组显著升高(P<0.05);同时,DHEAS、雄烯二酮和睾酮均较早初潮组高,子宫体积较正常和早初潮组显著增大。【结论】早初潮及GnRHa治疗有可能对BMI和糖代谢产生负面影响,GnRHa治疗者还伴雄激素分泌功能相对稍亢进。因此,建议早初潮女孩应监测胰岛素、血糖等糖代谢指标,GnRHa治疗的患儿应从治疗开始一直监测糖代谢指标至初潮后,从而早期发现、早期治疗可能存在的高胰岛素血症。[ Objective ] We assessed in a retrospective unicenter study the state of metabolism and gonadal axis of early men- arehe girls and girls who treated with Gonadotropin-releasing hormone analogs （GnRHa）. [Methods] Thirty-nine early menarche girls and 58 girls who had been treated with GnRHa were enrolled in our study and 19 normal menarche girls were enrolled as control group. Data were collected in height, weight, gonadal hormone, blood glucose, insulin, blood lipid, leptin, adiponectin and the size of uterus and ovary. [Results] Both BMI SDS for chronological age （CA） and for bone age （BA） of early menarche girls were signifi- cantly higher than normal menarche girls （P 〈 0.05 ）. The ratio of insulin resistance in early menarehe girls （20.5%） was also significantly higher than normal girls （0%）. No significant difference in lipid metabolism and gonadal axis between two groups. In girls treated with GnRHa, BMISDS, insulin, HOMA-IR and the ratio of insulin resistance （20.7%） were all significantly higher than normal group （P 〈 0.05）. Meanwhile, DHEAS, androstenedione and testosterone of GnRHa treated girls were significantly higher than early menache girls, and DHEAS was higher than normal girls. The size of uterus in treated group was larger than the other two groups. [ Conclusion ] Early meuarche and GnRHa treatment may take negative effect to BMI and glucose metabolism. Androgen was higher in GnRHa treated group. Therefore, suggestion was that BMI, insulin, blood glucose and androgen should be monitored in early menarche girls and girls treated with GnRHa.

关 键 词：早初潮 促性腺激素释放激素类似物 代谢 性腺轴 

分 类 号：R725.8[医药卫生—儿科]