男子肥胖儿少雌激素与雄激素比值变化初探
摘要
目的：近年来儿童少年肥胖的发生呈上升趋势。儿童少年肥胖会伴随性激素、性腺发育异常。男子肥胖儿童少年在青春期存在着“雌激素与雄激素比值升高”的现象,对于此现象在哪个生长发育阶段开始出现及其发生率无系统的研究；没有针对“雌激素与雄激素比值升高”现象在儿童期是否已出现,及其受青春期因素影响程度的调查。本研究由青春期初始阶段入手,调查男子肥胖儿少雌激素与雄激素比值的变化情况。初步探讨男子肥胖儿少此阶段的生长发育和性激素水平特点,以及进入青春期对男子肥胖儿少性激素水平变化的影响。
方法：选取105名9-12岁男性受试者,为其拍摄手-腕部骨龄片,以特征骨的出现界定受试者是否进入青春期。测量受试者身高、体重,根据中国肥胖问题工作组提出的BMI标准将未进入青春期和已进入青春期的受试者分别分为肥胖组、超重组和对照组。用独立样本t检验,比较各组身高、体重、年龄、骨龄差异性；观察各组受试者中进入青春期人数比例。以发光免疫法测定全部受试者睾酮、雌二醇,用非参数性检验比较各组间雌二醇、睾酮的差异。为未检出样本赋以最低检出值,计算各组雌二醇与睾酮比值模拟值,比较其高低分布情况。
结果：(1)肥胖组进入青春期的比率为34.6%,对照组进入青春期的比率为10.0%；同龄时肥胖组骨龄显著高于对照组,肥胖组身高、体重均有高于对照组的趋势。(2)肥胖组雌二醇、睾酮分布显著高于对照组；分别比较进入青春期前、后激素水平分布时,肥胖组雌二醇、睾酮分布均有高于对照组趋势。(3)肥胖组雌二醇与睾酮比值模拟值分布有低于对照组的趋势。
结论：(1)9-12岁男子肥胖儿少生长发育水平高于正常儿少。(2)9-12岁男子儿少,肥胖者雌激素和雄性激素水平均较高,进入青春期后这一现象变化不明显。(3)9-12岁男子肥胖儿少与正常儿少比较,雌激素与雄激素比值的差异不明显。
Object:There has been a rising trend of adolescents obesity in the last few years. Studies have suggested that childhood obesity will lead a"estrogen/testosterone rise", and even accompanied by gonadal abnormalities. Obesity male children and adolescents always have a increase on the rate of estradiol and testosterone in male obese children and adolescents. This study look through the period while puberty start to make a tentative research on the rate of estradiol and testosterone in male obese children and adolescents. The research discussed the hormone and growth difference between obesity male children and adolescents and normal ones, try to figure out the potential connection between obese and sex hormone during this age class.
Methods:We choose 1059-12 year-old male subjects. Use their bone age to group them as prepubertal and in puberty, while define their BMI in to three subjects as "control subjects", "overweight subjects"and"obese subjects". Test their serum testosterone and estradiol, use Mann-Whitney Test to compare the testosterone and estradiol level and E2/T between obese subjects and control subjects.
Results:(1) The 34.6% subjects reached puberty in obese subjects, while in control subjects is 34.6%. The bone age of obese subjects was significantly higher than control subjects. (2) Obese subjects have significantly higher testosterone and estradiol Mean Rank than control subjects. (3) Obese subjects showed a lower trend on E2/T Mean Rank than control subjects.
Conclusions:(1) 9-12 year-old obese male children and adolescents have higher level of growth and development than normal ones. (2) 9-12 year-old obese male children and adolescents have higher estradiol and testosterone level than non-obese ones, this trend doesn't change much after they achieve puberty. (3) 9-12 year-old obese and non-obese male children and adolescents have no significant difference on the rate of estradiol and testosterone.
方法：选取105名9-12岁男性受试者,为其拍摄手-腕部骨龄片,以特征骨的出现界定受试者是否进入青春期。测量受试者身高、体重,根据中国肥胖问题工作组提出的BMI标准将未进入青春期和已进入青春期的受试者分别分为肥胖组、超重组和对照组。用独立样本t检验,比较各组身高、体重、年龄、骨龄差异性；观察各组受试者中进入青春期人数比例。以发光免疫法测定全部受试者睾酮、雌二醇,用非参数性检验比较各组间雌二醇、睾酮的差异。为未检出样本赋以最低检出值,计算各组雌二醇与睾酮比值模拟值,比较其高低分布情况。
结果：(1)肥胖组进入青春期的比率为34.6%,对照组进入青春期的比率为10.0%；同龄时肥胖组骨龄显著高于对照组,肥胖组身高、体重均有高于对照组的趋势。(2)肥胖组雌二醇、睾酮分布显著高于对照组；分别比较进入青春期前、后激素水平分布时,肥胖组雌二醇、睾酮分布均有高于对照组趋势。(3)肥胖组雌二醇与睾酮比值模拟值分布有低于对照组的趋势。
结论：(1)9-12岁男子肥胖儿少生长发育水平高于正常儿少。(2)9-12岁男子儿少,肥胖者雌激素和雄性激素水平均较高,进入青春期后这一现象变化不明显。(3)9-12岁男子肥胖儿少与正常儿少比较,雌激素与雄激素比值的差异不明显。
Object:There has been a rising trend of adolescents obesity in the last few years. Studies have suggested that childhood obesity will lead a"estrogen/testosterone rise", and even accompanied by gonadal abnormalities. Obesity male children and adolescents always have a increase on the rate of estradiol and testosterone in male obese children and adolescents. This study look through the period while puberty start to make a tentative research on the rate of estradiol and testosterone in male obese children and adolescents. The research discussed the hormone and growth difference between obesity male children and adolescents and normal ones, try to figure out the potential connection between obese and sex hormone during this age class.
Methods:We choose 1059-12 year-old male subjects. Use their bone age to group them as prepubertal and in puberty, while define their BMI in to three subjects as "control subjects", "overweight subjects"and"obese subjects". Test their serum testosterone and estradiol, use Mann-Whitney Test to compare the testosterone and estradiol level and E2/T between obese subjects and control subjects.
Results:(1) The 34.6% subjects reached puberty in obese subjects, while in control subjects is 34.6%. The bone age of obese subjects was significantly higher than control subjects. (2) Obese subjects have significantly higher testosterone and estradiol Mean Rank than control subjects. (3) Obese subjects showed a lower trend on E2/T Mean Rank than control subjects.
Conclusions:(1) 9-12 year-old obese male children and adolescents have higher level of growth and development than normal ones. (2) 9-12 year-old obese male children and adolescents have higher estradiol and testosterone level than non-obese ones, this trend doesn't change much after they achieve puberty. (3) 9-12 year-old obese and non-obese male children and adolescents have no significant difference on the rate of estradiol and testosterone.
引文
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[3]常波.运动与下丘脑-垂体-性腺轴(之一：下丘脑-垂体-性腺轴的调控)[J].沈阳体育学院学报,2005,24(5)：7-11.
[4]刘乃琴.瘦素与下丘脑-垂体-性腺轴[J].国外医学内分泌学分册,2003,20(6)：308-311.
[5]刘春丽.糖皮质激素对下丘脑-垂体-性腺(HPG)轴的影响[J].沈阳体育学院学报,2004,28(1)：71-74.
[6]李涛.褪黑素对男性下丘脑—垂体—性腺轴的调节作用[J].现代生物医学进展,2006,6(10)119-121.
[7]黄诚.细胞因子对下丘脑-垂体-性腺轴的调控[J].《国外医学》内分泌学分册,1997,17(1)：16-19.
[8]杨军.脂联素与下丘脑—垂体—性腺轴关系的研究进展[J].国际内分泌代谢杂志,2006,26(3)：207-208.
[9]周劲松.一氧化氮在下丘脑-垂体-性腺轴中的作用[J].国外医学内分泌学分册,1999,19(3)：106-109.
[10]薛长勇.葡萄糖对下丘脑腹内侧核损伤性肥胖大鼠脂质代谢的影响[J].营养学报2003,25(2)：95-97.
[11]C Denzer, A Weibel. Pedistric Highlight:Pubertal development in obese children and adolescents[J].International Journal of Obesity (2007) 31,1509-1519
[12]Karen Oerter Klein. Effect of Obesity on Estradiol Level, and Its Relationship to Leptin, Bone Maturation, and Bone Mineral Density in Children[J].Journal of Clinical Endocrinology and Metabolism,1998,83 (10)
[13]Thomas Reinehr, Gideon de Sousa. Androgens before and after Weight Loss in Obese Children[J].The Journal of Clinical Endocrinology & Metabolism,2005,90 (10):5588-5595.
[14]娄晓民.青春期肥胖儿童血清瘦素及相关激素的测定[J]郑州大学学报(医学版),2007,42(4)：700-703.
[15]李正秋.肥胖男童性腺激素检测临床价值的探讨[J].广西医学,2003,25(12)：2427-2428.
[16]张迎修.肥胖儿童少年骨发育的对比观察[J].现代预防医学,1996,23(1)：53-54.
[17]娄晓民.13岁儿童肥胖发生相关因子与青春期发育相关激素分泌及其关系研究[J].卫生研究,2006,35(4)：468-471.
[18]张国栋.儿童少年骨龄变化规律的追踪研究及应用[J].中国学校卫生,1991,12(6)：
321-325.
[19]艾赛提·克里木.骨龄与青少年生长发育[J].放射学实践,2004,19(10)：776-777.
[20]白英龙.青春早期男童体成分与骨龄及性发育关系研究[J]．中国学校卫生,2008,29(4)：297-298.
[21]冯冰.单纯性肥胖男孩血清LePtin与性激素的关系[J].中国当代儿科杂志,2002,4(2)：113-114.
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