Ibáñez Lourdes, Ong Ken, de Zegher Francis, Marcos Maria Victoria, del Rio Luis, Dunger David B
Endocrine Unit, Hospital Sant Joan de Déu, University of Barcelona, Spain.
Clin Endocrinol (Oxf). 2003 Mar;58(3):372-9. doi: 10.1046/j.1365-2265.2003.01728.x.
Precocious pubarche (PP) in girls is associated with hyperinsulinaemia and dyslipidaemia of prepubertal onset, and with ovarian hyperandrogenism and ovulatory dysfunction in adolescence, particularly if they also had prenatal growth restraint and postnatal growth acceleration. Hyperinsulinaemia may be the pathogenic key factor, possibly amplified by hyperandrogenaemia. While such PP girls do not have increased body mass index (BMI), we hypothesized that body fat mass and fat distribution may differ between PP girls and matched controls, and may relate to insulin and androgen levels.
Sixty-seven PP girls (age range 6.0-18.0 years) and 65 control girls matched for age and pubertal stage (5.9-18.0 years) had height, weight, waist and hip circumferences measured, and dual-energy X-ray absorptiometry (DXA) assessment of total body fat mass, and fat mass in abdominal and truncal regions. All girls had fasting plasma glucose, serum insulin, lipids, testosterone and SHBG levels measured; PP girls also had a standard 2-h oral glucose tolerance test (oGTT).
Despite no differences in BMI, PP girls had significantly larger waist circumference, waist-to-hip ratio, total fat mass, percentage fat mass, abdominal fat mass, and truncal fat mass vs. controls in each pubertal stage. Overall, fasting insulin levels, free androgen index (FAI) and blood lipid levels were more closely related to central fat than to total body fat mass. In a multiple regression analysis, truncal fat mass was independently related to both fasting insulin (P = 0.009) and FAI (P < 0.0001). Abdominal fat mass was inversely related to birthweight (r = -0.25, P = 0.001). In PP girls, central fat mass was positively related to insulin levels after oGTT (truncal fat vs. 30 min insulin; r = 0.46, P < 0.0005).
Precocious pubarche girls had excess total body and central fat mass throughout all pubertal stages, and increased central fat was related to hyperinsulinaemia and hyperandrogenaemia. It remains to be verified whether body composition in PP girls can be normalized by insulin-sensitization and/or antiandrogen therapy.
女童性早熟（PP）与青春期前开始的高胰岛素血症和血脂异常有关，与青春期的卵巢雄激素过多和排卵功能障碍有关，尤其是当她们还存在产前生长受限和产后生长加速的情况时。高胰岛素血症可能是致病的关键因素，雄激素过多可能会加剧这种情况。虽然这些PP女童的体重指数（BMI）并未升高，但我们推测PP女童与匹配的对照组之间的体脂量和脂肪分布可能存在差异，且可能与胰岛素和雄激素水平有关。
67名PP女童（年龄范围6.0 - 18.0岁）和65名年龄及青春期阶段匹配的对照女童（5.9 - 18.0岁）测量了身高、体重、腰围和臀围，并采用双能X线吸收法（DXA）评估了全身脂肪量以及腹部和躯干区域的脂肪量。所有女童均测量了空腹血糖、血清胰岛素、血脂、睾酮和性激素结合球蛋白（SHBG）水平；PP女童还进行了标准的2小时口服葡萄糖耐量试验（oGTT）。
尽管BMI无差异，但在每个青春期阶段，PP女童的腰围、腰臀比、总脂肪量、脂肪量百分比、腹部脂肪量和躯干脂肪量均显著高于对照组。总体而言，空腹胰岛素水平、游离雄激素指数（FAI）和血脂水平与中心性脂肪的关系比与全身脂肪量的关系更为密切。在多元回归分析中，躯干脂肪量与空腹胰岛素（P = 0.009）和FAI（P < 0.0001）均独立相关。腹部脂肪量与出生体重呈负相关（r = -0.25，P = 0.001）。在PP女童中，oGTT后中心性脂肪量与胰岛素水平呈正相关（躯干脂肪与30分钟时胰岛素水平；r = 0.46，P < 0.0005）。
性早熟女童在所有青春期阶段全身和中心性脂肪量均过多，且中心性脂肪增加与高胰岛素血症和高雄激素血症有关。PP女童的身体成分是否能通过胰岛素增敏和/或抗雄激素治疗恢复正常仍有待验证。
