Jiang You-zhi, Zhu Min, Xiong Feng, Deng Lei-li, Luo Yan-hong
Department of Pediatric Endocrinology, The Affiliated Children's Hospital of Chongqing University of Medical Sciences, Chongqing 400014, China.
Zhonghua Er Ke Za Zhi. 2006 Jan;44(1):37-40.
To investigate whether the association between low birth weight and increased risk of developing premature adrenarche, adrenal hyperandrogenism, hyperinsulinism and insulin resistance is apparent in prepubertal girls born small for gestational age (SGA) and analyze when adrenarche occurs in SGA infants and normal birth weight girls.
The study was performed in 39 prepubertal SGA girls with a mean age of 7.4 +/- 1.7 years and 42 prepubertal appropriate for gestational age (AGA) girls with a mean age of 7.4 +/- 1.7 years served as controls. All children were born at term and were prepubertal. Detailed physical examination was performed for all the children after 12 h of overnight fasting. Blood samples were taken for the measurement of fasting glucose (FPG), insulin (FIns), dehydroepiandrosterone sulfate (DHEAS), cortisol and estradiol concentrations. Insulin sensitivity was assessed by insulin sensitivity index [IAI = log(e) (FPG x FIns)].
There was no premature adrenarche in SGA and AGA groups. Birth weight was significantly lower in SGA group (P < 0.001). Gestational age was similar in both groups. At the time of the study, the ages, body mass index (BMI), fasting glucose, cortisol and estradiol did not significantly differ between the two groups. But body height and weight were significantly lower in the SGA group (P < 0.05 for both). The fasting plasma insulin in the SGA group was higher than that in AGA group (common logarithmic transformation: 1.076 +/- 0.041 vs. 1.050 +/- 0.051, P < 0.05). The insulin sensitivity index was not significantly different between the two groups (-4.0165 +/- 0.1761 vs. -3.9768 +/- 0.2314). The serum DHEAS was significantly higher in SGA children than in AGA children (common logarithmic transformation: 2.637 +/- 0.271 vs. 2.514 +/- 0.250, P < 0.05). From about age 7 the concentration of DHEAS had a gradual rise in AGA children. The time of DHEAS rise tended to be earlier in SGA children compared with AGA children.
Adrenarche commences at approximately 7 years of age in AGA girls. The time of adrenarche tended to be earlier in SGA girls compared with AGA girls. There were adrenal hyperandrogenism and hyperinsulinism in prepubertal girls born small for gestational age. But there was no insulin resistance as assessed by insulin sensitivity index.
研究小于胎龄儿（SGA）出生的青春期前女孩中，低出生体重与过早出现肾上腺初现、肾上腺雄激素过多、高胰岛素血症和胰岛素抵抗风险增加之间的关联是否明显，并分析SGA婴儿和正常出生体重女孩肾上腺初现的发生时间。
该研究纳入了39名平均年龄为7.4±1.7岁的青春期前SGA女孩，并以42名平均年龄为7.4±1.7岁的青春期前适于胎龄儿（AGA）女孩作为对照。所有儿童均足月出生且处于青春期前。所有儿童在过夜禁食12小时后进行详细的体格检查。采集血样以测定空腹血糖（FPG）、胰岛素（FIns）、硫酸脱氢表雄酮（DHEAS）、皮质醇和雌二醇浓度。通过胰岛素敏感指数[IAI = log(e)(FPG×FIns)]评估胰岛素敏感性。
SGA组和AGA组均未出现过早肾上腺初现。SGA组出生体重显著更低（P<0.001）。两组的胎龄相似。在研究时，两组之间的年龄、体重指数（BMI）、空腹血糖、皮质醇和雌二醇无显著差异。但SGA组身高和体重显著更低（两者均P<0.05）。SGA组空腹血浆胰岛素高于AGA组（常用对数转换：1.076±0.041对1.050±0.051，P<0.05）。两组之间胰岛素敏感指数无显著差异（-4.0165±0.1761对-3.9768±0.2314）。SGA儿童血清DHEAS显著高于AGA儿童（常用对数转换：2.637±0.271对2.514±0.250，P<0.05）。从约7岁起，AGA儿童DHEAS浓度逐渐升高。与AGA儿童相比，SGA儿童DHEAS升高时间倾向于更早。
AGA女孩肾上腺初现约在7岁开始。与AGA女孩相比，SGA女孩肾上腺初现时间倾向于更早。小于胎龄出生的青春期前女孩存在肾上腺雄激素过多和高胰岛素血症。但根据胰岛素敏感指数评估，不存在胰岛素抵抗。
