University of Health Sciences Turkey, İstanbul Prof. Dr. Cemil Taşçıoğlu City Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
Trakya University Faculty of Medicine, Department of Pediatrics, Clinic of Pediatric Endocrinology, Edirne, Turkey
J Clin Res Pediatr Endocrinol. 2022 Dec 1;14(4):385-392. doi: 10.4274/jcrpe.galenos.2022.2022-1-1. Epub 2022 May 31.
Premature pubarche (PP) is a risk factor for metabolic syndrome (MS). The aim was to evaluate if glucose-insulin metabolism, cardiovascular risk factors, familial cardiovascular risk factors (FCVRF) created a risk for insulin resistance (IR) and if PP was a risk factor alone for MS in normal weight prepubertal girls with PP.
Thirty-five prepubertal, non-obese girls with PP with normal birth weight and 35 age-matched control girls were evaluated for FCVRF, anthropometric measurements, blood pressure, lipid profile, fasting blood glucose-insulin, hemoglobin A1c (HbA1c), sex hormone binding globulin (SHBG), leptin, adiponectin, tumor necrosis factor-alpha (TNF-α), androgen levels, and bone age. Oral glucose tolerance test was performed in PP participants. Homeostasis model of assessment of IR (HOMA-IR), fasting glucose/insulin ratio, atherogenic index (AI), and free androgen index (FAI) were calculated. PP participants were further stratified by FCVRF.
HbA1c, lipid profile, testosterone, leptin, adiponectin, TNF-α, HOMA-IR, glucose/insulin ratio, AI, and fasting glucose-insulin levels were similar. In the PP group FAI was significantly higher (p=0.001), whereas SHBG was significantly lower (p=0.010) than the control group. Leptin levels of FCVRF+ and FCVRF- subgroups were 15.2±9.1 and 9.7±7.2 ng/mL, respectively and the difference was significant (p=0.016).
As PP does not appear to be a risk factor alone for impaired glucose metabolism and IR in prepubertal non-obese girls with normal birth weight, it is our opinion that it is unnecessary to examine in detail such cases before puberty. Low SHBG levels in the PP group and high leptin levels in FCVRF+ subgroup might suggest that these may be predictive for MS in the future.
性早熟（PP）是代谢综合征（MS）的一个危险因素。目的是评估葡萄糖-胰岛素代谢、心血管危险因素、家族心血管危险因素（FCVRF）是否会增加胰岛素抵抗（IR）的风险，以及 PP 是否是正常体重青春期前女孩伴发 PP 的 MS 的单一危险因素。
评估了 35 名伴有正常出生体重的青春期前非肥胖性早熟女孩（PP 组）和 35 名年龄匹配的对照组女孩的 FCVRF、人体测量学指标、血压、血脂谱、空腹血糖-胰岛素、糖化血红蛋白（HbA1c）、性激素结合球蛋白（SHBG）、瘦素、脂联素、肿瘤坏死因子-α（TNF-α）、雄激素水平和骨龄。PP 组参与者进行口服葡萄糖耐量试验。计算稳态模型评估的胰岛素抵抗指数（HOMA-IR）、空腹血糖/胰岛素比值、致动脉粥样硬化指数（AI）和游离雄激素指数（FAI）。根据 FCVRF 对 PP 参与者进行进一步分层。
HbA1c、血脂谱、睾酮、瘦素、脂联素、TNF-α、HOMA-IR、空腹血糖/胰岛素比值、AI 和空腹血糖-胰岛素水平在两组之间无差异。PP 组的 FAI 明显高于（p=0.001），而 SHBG 明显低于（p=0.010）对照组。FCVRF+和 FCVRF-亚组的瘦素水平分别为 15.2±9.1 和 9.7±7.2 ng/mL，差异有统计学意义（p=0.016）。
由于性早熟似乎不是正常体重青春期前非肥胖女孩葡萄糖代谢受损和 IR 的单一危险因素，我们认为在青春期前没有必要详细检查此类病例。PP 组中 SHBG 水平较低，FCVRF+亚组中瘦素水平较高，这可能表明这些因素可能是未来 MS 的预测因素。
