早初潮及GnRHa治疗女孩初潮后代谢和性腺轴的改变

发布时间：2018-04-15 15:21

本文选题：早初潮 + 促性腺激素释放激素类似物　；参考：《中山大学学报(医学科学版)》2017年03期

【摘要】：【目的】探讨早初潮女孩及应用过促性腺激素释放激素类似物(GnRHa)治疗的女孩代谢和性腺轴的改变。【方法】选取我院因早初潮就诊39例,曾应用GnRHa治疗并已呈现初潮女孩58例作为研究对象,并以正常初潮19例作为对照。测量身高、体重,B超测量子宫、卵巢大小,抽血查性激素及胰岛素、血糖、血脂、leptin、adiponectin等代谢指标。【结果】早初潮女孩年龄别和骨龄别体质指数标准差分值(BMISDS)均较正常初潮女孩显著增高(P0.05),发生胰岛素抵抗的比例(20.5%)亦较正常初潮女孩(0%)显著升高,而脂代谢和性腺轴各项指标均无差异。GnRHa治疗者初潮后BMISDS和胰岛素、HOMA-IR及发生胰岛素的比例(20.7%)均较正常初潮组显著升高(P0.05);同时,DHEAS、雄烯二酮和睾酮均较早初潮组高,子宫体积较正常和早初潮组显著增大。【结论】早初潮及GnRHa治疗有可能对BMI和糖代谢产生负面影响,GnRHa治疗者还伴雄激素分泌功能相对稍亢进。因此,建议早初潮女孩应监测胰岛素、血糖等糖代谢指标,GnRHa治疗的患儿应从治疗开始一直监测糖代谢指标至初潮后,从而早期发现、早期治疗可能存在的高胰岛素血症。
[Abstract]:[objective] to investigate the changes of metabolism and gonadal axis in girls with early menarche and those who had been treated with gonadotropin releasing hormone analogue (GnRHa). [methods] 39 cases of early menarche in our hospital were selected.58 cases of girls with menarche were treated with GnRHa and 19 cases of normal menarche were used as control.Measure height, weight, size of uterus and ovary, measure sex hormone, insulin, blood sugar,[results] the BMISDSs of age and bone age of early menarche girls were significantly higher than those of normal menarche girls (P 0.05), and the proportion of insulin resistance (20. 5%) was significantly higher than that of normal menarche girls.However, there was no difference in lipid metabolism and gonadal axis. The levels of BMISDS, HOMA-IR and the ratio of insulin to insulin in the patients with menarche were significantly higher than those in the normal menarche group, and the levels of DHEAS, androstenedione and testosterone were higher than those in the early menarche group.[conclusion] early menarche and GnRHa therapy may have a negative effect on BMI and glucose metabolism.Therefore, it is suggested that early menarche girls should be monitored for insulin, glucose and other glucose metabolism indexes. The children treated with GnRHa should monitor glucose metabolism from the beginning of treatment to after menarche, so as to find the possible hyperinsulinemia in early treatment.
【作者单位】：中山大学附属第一医院儿科;
【基金】：广东省医学科研基金(A2015303)
【分类号】：R725.8

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