Early metformin therapy to delay menarche and augment height in girls with precocious pubarche
Early metformin therapy to delay menarche and augment height in girls with precocious pubarche
复制标题
DOI：
10.1016/j.fertnstert.2010.08.052
复制
发表时间：
2011-02-01
影响因子：
6.7
通讯作者：
de Zegher, Francis
中科院分区：
文献类型：
--
作者：
Ibanez, Lourdes;Lopez-Bermejo, Abel;de Zegher, Francis
目的：探讨早期二甲双胍治疗对初潮、身高及多囊卵巢综合征（PCOS）指标的影响。低出生体重（LBW）的青春期早熟（PP）女孩有月经初潮早（< 12岁）、成人身高低于目标水平和多囊卵巢综合征的风险。高胰岛素血症胰岛素抵抗被认为是一个关键因素。设计：开放标签，随机研究。单位：大学医院。患者：38名LBW-PP女孩。干预措施：在8岁时，女孩被随机分配为不治疗或接受二甲双胍治疗4年；随后，两个亚组在没有治疗的情况下进行随访，直到每个女孩月经初潮后。主要结局指标：初潮年龄、身高、体重、内分泌代谢状态（空腹血）、身体组成（通过吸收仪）、腹部脂肪（皮下脂肪vs内脏脂肪）和肝脏脂肪（通过磁共振成像）。结果：最后一次评估时，各亚组女孩月经初潮平均后2年；平均生长速度低于2 cm/年。未经治疗的女孩初潮年龄为11.4 +/- 0.1岁，二甲双胍治疗的女孩初潮年龄为12.5 +/- 0.2岁；后者的女孩更高，更瘦（内脏和肝脏脂肪较少），循环胰岛素、雄激素和脂质水平更有利。结论：早期二甲双胍治疗（8-12岁）足以延缓月经初潮；增加月经初潮后的高度；减少总脂肪、内脏脂肪和肝脏脂肪；抑制LBW-PP女孩的内分泌代谢过程，使其远离青春期多囊卵巢综合征。[j] .中国农业科学（英文版），2011;35(5):727- 730。(C) 2011年美国生殖医学学会。)
Objective: To study the effects of early metformin treatment on menarche, height, and polycystic ovary syndrome (PCOS) markers. Low-birthweight (LBW) girls with precocious pubarche (PP) are at risk for an early menarche (< 12 years), an adult stature below target level, and PCOS. Hyperinsulinemic insulin resistance is thought to be a key factor.Design: Open-label, randomized study.Setting: University hospital.Patient(s): Thirty-eight LBW-PP girls.Intervention(s): At age 8 years, girls were randomly assigned to remain untreated or to receive metformin for 4 years; subsequently, both subgroups were followed without treatment until each girl was postmenarcheal.Main Outcome Measure(s): Age at menarche, height, weight, endocrine-metabolic state (fasting blood), body composition (by absorptiometry), abdominal fat (subcutaneous vs. visceral), and hepatic adiposity (by magnetic resonance imaging).Result(s): At last assessment, girls in each subgroup were on average 2 years beyond menarche; the mean growth velocity was below 2 cm/years. Age at menarche was 11.4 +/- 0.1 years in untreated girls and 12.5 +/- 0.2 years in metformin-treated girls; the latter girls were taller and much leaner (with less visceral and hepatic fat) and had more favorable levels of circulating insulin, androgens, and lipids.Conclusion(s): Early metformin therapy (age similar to 8-12 years) suffices to delay menarche; to augment postmenarcheal height; to reduce total, visceral, and hepatic adiposity; and to curb the endocrine-metabolic course of LBW-PP girls away from adolescent PCOS. (Fertil Steril(R) 2011;95:727-30. (C) 2011 by American Society for Reproductive Medicine.)