Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Endocrinol (Lausanne). 2023 May 24;14:1131438. doi: 10.3389/fendo.2023.1131438. eCollection 2023.
The aim of this study was to assess whether size for gestational age and dehydroepiandrosterone sulfate (DHEAS) are associated with cardiometabolic risk in central precocious puberty (CPP) girls.
The retrospective study included 443 patients with newly diagnosed CPP. Subjects were categorized by birth weight for gestational age (appropriate [AGA], small [SGA], and large [LGA] for gestational age) and serum DHEAS concentration (high [≥75th percentile] and normal [<75th percentile] DHEAS). Cardiometabolic parameters were examined. Composite cardiometabolic risk (CMR) score was calculated based on BMI, blood pressure, glucose, insulin, triglyceride, and HDL cholesterol. Non-obesity CMR score was computed, omitting the value from BMI. Logistic regression models, general linear models, and partial correlation analyses were used to evaluate associations. Propensity score matching was performed for sensitivity analyses.
Overall, 309 patients (69.8%) were born AGA, 80 (18.1%) were born SGA, and 54 (12.2%) were born LGA. Compared with AGA counterparts, CPP girls born SGA were more prone to have elevated HbA1c (adjusted OR = 4.54; 95% CI, 1.43-14.42) and low HDL cholesterol (adjusted OR = 2.33; 95% CI, 1.18-4.61). In contrast, being born LGA was not associated with increased risk for any glucose or lipid derangements. Despite the fact that elevated CMR score was more common among individuals born LGA than AGA (adjusted OR = 1.84; 95% CI, 1.07-4.35), no significant difference was found on non-obesity CMR score (adjusted OR = 0.75; 95% CI, 0.30-1.88). When controlling for age, birth weight SDS, and current BMI-SDS, individuals with high DHEAS exhibited higher HDL cholesterol and apolipoprotein A-1 concentrations and lower triglyceride level and non-obesity CMR score. Furthermore, DHEAS correlated positively with HDL cholesterol and apolipoprotein A-1 and negatively with triglyceride, prominently in girls born SGA, after adjustments for the three abovementioned confounders. Sensitivity analyses corroborated the findings.
Among CPP girls, those born SGA were more likely to possess cardiometabolic risk factors compared to their AGA peers. The difference we observed in cardiometabolic risk between individuals born LGA and AGA was driven by BMI. High DHEAS was associated with favorable lipid profile in CPP girls, even in subjects born SGA.
本研究旨在评估胎儿生长发育时期的大小和硫酸脱氢表雄酮（DHEAS）与中枢性性早熟（CPP）女孩的心血管代谢风险是否相关。
本回顾性研究纳入了 443 例新诊断为 CPP 的患者。根据出生体重与胎龄的关系（适宜[AGA]、小[SGA]和大[LGA]）和血清 DHEAS 浓度（高[≥75 百分位数]和正常 [<75 百分位数]DHEAS）对患者进行分类。检测了心血管代谢参数。基于 BMI、血压、血糖、胰岛素、甘油三酯和高密度脂蛋白胆固醇，计算了复合心血管代谢风险（CMR）评分。计算了非肥胖 CMR 评分，即排除 BMI 的值。使用逻辑回归模型、一般线性模型和偏相关分析来评估相关性。进行了倾向评分匹配以进行敏感性分析。
总体而言，309 例（69.8%）患者为 AGA 出生，80 例（18.1%）为 SGA 出生，54 例（12.2%）为 LGA 出生。与 AGA 患者相比，SGA 出生的 CPP 女孩更容易出现 HbA1c 升高（调整后的比值比=4.54；95%置信区间，1.43-14.42）和高密度脂蛋白胆固醇降低（调整后的比值比=2.33；95%置信区间，1.18-4.61）。相比之下，LGA 出生与任何血糖或脂质异常无关。尽管 LGA 出生的个体发生 CMR 评分升高的可能性高于 AGA 出生的个体（调整后的比值比=1.84；95%置信区间，1.07-4.35），但非肥胖 CMR 评分没有差异（调整后的比值比=0.75；95%置信区间，0.30-1.88）。在校正年龄、出生体重标准差和当前 BMI-SDS 后，DHEAS 高的个体表现出更高的高密度脂蛋白胆固醇和载脂蛋白 A-1 浓度以及更低的甘油三酯水平和非肥胖 CMR 评分。此外，在校正上述三个混杂因素后，DHEAS 与高密度脂蛋白胆固醇和载脂蛋白 A-1 呈正相关，与甘油三酯呈负相关，在 SGA 出生的女孩中更为明显。敏感性分析证实了这些发现。
在 CPP 女孩中，与 AGA 同龄人相比，SGA 出生的女孩更有可能存在心血管代谢危险因素。我们观察到 LGA 和 AGA 出生的个体之间的心血管代谢风险差异是由 BMI 驱动的。即使在 SGA 出生的个体中，高 DHEAS 也与有利的血脂谱相关。
