Divisions of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Clin Endocrinol (Oxf). 2013 Jun;78(6):907-13. doi: 10.1111/cen.12079. Epub 2013 Apr 6.
Turner syndrome (TS) confers increased lifetime risk of type 2 diabetes mellitus and cardiovascular disease. We compared cardiometabolic risk factors and measures of subcutaneous, visceral adipose tissue and intra-myocellular lipid between young TS girls and an age- and BMI-standard deviation scores (SDS)-matched healthy female cohort.
A cross-sectional cohort study was conducted at the Hospital for Sick Children, Toronto. Nineteen TS and 17 control girls (13.7 ± 2.5 vs 12.7 ± 3.4 years of age, respectively, P = 0.30). Multiple-sample oral glucose tolerance test with measurement of fasting insulin, LDL, HDL, triglycerides, adiponectin and highly sensitive C-reactive protein (hsCRP) was performed. Subcutaneous adipose tissue, visceral adipose tissue intramyocellular lipid levels evaluated by magnetic resonance techniques. Insulin secretion (IS), sensitivity (Si) and the insulin secretion-sensitivity index (ISSI-2) were calculated from oral glucose tolerance test data.
Five TS and no controls had impaired fasting glucose or impaired glucose tolerance; none had type 2 diabetes mellitus. Insulin sensitivity and insulin secretion were similar between groups; ISSI-2 was lower in TS (923.5 ± 307.3 vs 659.1 ± 387.3; P = 0.03). TS girls had higher blood pressure (82.5 ± 13.6 vs 73.5 ± 5.5 mmHg; P = 0.0146), waist circumference (76.0 ± 11.8 vs 65.9 ± 9.7; P = 0.0087) and subcutaneous adipose tissue (135.6 ± 88.6 vs 69.3 ± 59.9; P = 0.01) than controls. Visceral adipose tissue, intramyocellular lipid levels and adiponectin were not different between groups. TS girls also had higher triglycerides (1.1 ± 0.6 vs 0.7 ± 0.3; P = 0.003), total cholesterol (4.4 ± 0.7 vs 3.9 ± 0.4; P = 0.02) and hsCRP (2.0 ± 1.9 vs 0.8 ± 0.3; P = 0.01).
TS girls exhibit more cardiometabolic risk factors and reduced beta cell function compared with age- and BMI-SDS-matched girls. Increased awareness of early risk of type 2 diabetes mellitus and hypertension in TS girls is needed.
特纳综合征（TS）会增加患者一生中罹患 2 型糖尿病和心血管疾病的风险。我们对比了年轻 TS 女孩与年龄和 BMI 标准差评分（SDS）匹配的健康女性队列之间的心血管代谢危险因素以及皮下、内脏脂肪组织和肌内细胞内脂质的指标。
这是一项在多伦多 SickKids 医院进行的横断面队列研究。19 名 TS 女孩和 17 名对照组女孩（年龄分别为 13.7 ± 2.5 岁和 12.7 ± 3.4 岁，P = 0.30）。对所有参与者进行了多样本口服葡萄糖耐量试验，检测空腹胰岛素、LDL、HDL、甘油三酯、脂联素和高敏 C 反应蛋白（hsCRP）。采用磁共振技术评估皮下脂肪组织、内脏脂肪组织和肌内细胞内脂质水平。根据口服葡萄糖耐量试验数据计算胰岛素分泌（IS）、敏感性（Si）和胰岛素分泌-敏感性指数（ISSI-2）。
5 名 TS 女孩和无对照组女孩出现空腹血糖受损或糖耐量受损；但均无 2 型糖尿病。两组的胰岛素敏感性和胰岛素分泌相似；TS 组的 ISSI-2 较低（923.5 ± 307.3 比 659.1 ± 387.3；P = 0.03）。TS 女孩的血压（82.5 ± 13.6 比 73.5 ± 5.5mmHg；P = 0.0146）、腰围（76.0 ± 11.8 比 65.9 ± 9.7cm；P = 0.0087）和皮下脂肪组织（135.6 ± 88.6 比 69.3 ± 59.9cm；P = 0.01）高于对照组。两组间内脏脂肪组织、肌内细胞内脂质水平和脂联素无差异。TS 女孩的甘油三酯（1.1 ± 0.6 比 0.7 ± 0.3mmol/L；P = 0.003）、总胆固醇（4.4 ± 0.7 比 3.9 ± 0.4mmol/L；P = 0.02）和 hsCRP（2.0 ± 1.9 比 0.8 ± 0.3mg/L；P = 0.01）也较高。
与年龄和 BMI-SDS 匹配的女孩相比，TS 女孩表现出更多的心血管代谢危险因素和较低的胰岛β细胞功能。需要提高对 TS 女孩发生 2 型糖尿病和高血压早期风险的认识。
