Ahmed M L, Connors M H, Drayer N M, Jones J S, Dunger D B
Department of Paediatrics, University of Oxford, U.K.
Diabetes Care. 1998 May;21(5):831-5. doi: 10.2337/diacare.21.5.831.
In cross-sectional studies of subjects with IDDM, the relationship between suboptimal pubertal growth, glycemic control, and abnormal insulin-like growth factor I (IGF-I) levels has proved difficult to define. The objective of this study was to examine these relationships in a longitudinal prospective study.
A total of 46 children (23 boys) were measured every 3 months, and their bone age was assessed annually. Blood samples were obtained for HbA1c, IGF-I, and C-peptide. Growth data were compared with national standards, and IGF-I data were compared with a parallel longitudinal study of normal schoolchildren. Data were analyzed as SD scores (mean +/- SD).
The onset of puberty was not delayed, although in the girls, bone age was advanced (bone age, 11.48 +/- 1.01 years vs. chronological age, 10.93 +/- 0.86 years [mean +/- SD]; P = 0.04). The timing of peak height velocity (PHV) was normal in both sexes, but the magnitude was reduced in girls (PHV SDS = -0.56 +/- 0.90, P < 0.02), and reductions in height SDS between diagnosis and final height were observed (P = 0.014). At PHV, IGF-I levels were reduced in both sexes, and there were no sex differences in HbA1c levels and insulin doses. IGF-I SDS correlated with insulin dose (r = 0.47, P = 0.004) but not with PHV SDS, whereas HbA1c correlated negatively with PHV SDS in both sexes (r = -0.35, P = 0.03). In a stepwise multiple regression analysis, the major determinants of PHV SDS were HbA1c (P = 0.04), sex (P = 0.0007), and bone age (P = 0.01).
We conclude that the magnitude of the pubertal growth spurt is related to HbA1c levels in both sexes, but it is reduced only in girls. This sexual dimorphism cannot be explained by differences in IGF-I levels and may relate to the bone age advance at the onset of puberty in the girls.
在对胰岛素依赖型糖尿病（IDDM）患者的横断面研究中，青春期生长发育欠佳、血糖控制及胰岛素样生长因子I（IGF-I）水平异常之间的关系一直难以明确。本研究的目的是在一项纵向前瞻性研究中探讨这些关系。
每3个月对46名儿童（23名男孩）进行一次测量，并每年评估他们的骨龄。采集血样检测糖化血红蛋白（HbA1c）、IGF-I和C肽。将生长数据与国家标准进行比较，将IGF-I数据与一项针对正常学童的平行纵向研究进行比较。数据以标准差分数（均值±标准差）进行分析。
青春期开始并未延迟，不过在女孩中，骨龄提前（骨龄为11.48±1.01岁，而实际年龄为10.93±0.86岁[均值±标准差]；P = 0.04）。两性的身高增长高峰期（PHV）时间正常，但女孩的增长幅度降低（PHV SDS = -0.56±0.90，P < 0.02），且观察到从诊断到最终身高期间身高SDS有所下降（P = 0.014）。在PHV时，两性的IGF-I水平均降低，HbA1c水平和胰岛素剂量不存在性别差异。IGF-I SDS与胰岛素剂量相关（r = 0.47，P = 0.004），但与PHV SDS无关，而HbA1c在两性中均与PHV SDS呈负相关（r = -0.35，P = 0.03）。在逐步多元回归分析中，PHV SDS的主要决定因素是HbA1c（P = 0.04）、性别（P = 0.0007）和骨龄（P = 0.0l）。
我们得出结论，青春期生长突增的幅度在两性中均与HbA1c水平相关，但仅在女孩中降低。这种性别差异不能用IGF-I水平的差异来解释，可能与女孩青春期开始时骨龄提前有关。
