文章摘要
段晓楠,严双琴,汪素美,胡晶晶,方姣,龚纯,万宇辉,苏普玉,陶芳标,孙莹.下丘脑-垂体-肾上腺轴昼夜节律指标随青春期发育变化的特征[J].中华流行病学杂志,2018,39(8):1086-1090
下丘脑-垂体-肾上腺轴昼夜节律指标随青春期发育变化的特征
Developmental characteristics of circadian rhythms in hypothalamic-pituitary-adrenal axis during puberty
投稿时间:2018-02-07  
DOI:10.3760/cma.j.issn.0254-6450.2018.08.014
中文关键词: 下丘脑-垂体-肾上腺轴;昼夜节律;青春期
英文关键词: Hypothalamic-pituitary-adrenal axis;Circadian rhythm;Puberty
基金项目:国家自然科学基金(81673188);安徽省教育厅自然科学基金重点项目(KJ2016A338)
作者单位E-mail
段晓楠 230032 合肥, 安徽医科大学公共卫生学院儿少与妇幼保健学系/人口健康与优生安徽省重点实验室  
严双琴 243011 安徽省马鞍山市妇幼保健院  
汪素美 243011 安徽省马鞍山市妇幼保健院  
胡晶晶 230032 合肥, 安徽医科大学公共卫生学院儿少与妇幼保健学系/人口健康与优生安徽省重点实验室  
方姣 230032 合肥, 安徽医科大学公共卫生学院儿少与妇幼保健学系/人口健康与优生安徽省重点实验室  
龚纯 230032 合肥, 安徽医科大学公共卫生学院儿少与妇幼保健学系/人口健康与优生安徽省重点实验室  
万宇辉 230032 合肥, 安徽医科大学公共卫生学院儿少与妇幼保健学系/人口健康与优生安徽省重点实验室  
苏普玉 230032 合肥, 安徽医科大学公共卫生学院儿少与妇幼保健学系/人口健康与优生安徽省重点实验室  
陶芳标 230032 合肥, 安徽医科大学公共卫生学院儿少与妇幼保健学系/人口健康与优生安徽省重点实验室  
孙莹 230032 合肥, 安徽医科大学公共卫生学院儿少与妇幼保健学系/人口健康与优生安徽省重点实验室 sy54@yeah.net 
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中文摘要:
      目的 描述下丘脑-垂体-肾上腺(HPA)轴昼夜节律指标随青春期发育变化的特征。方法 2015年10月选择安徽省马鞍山市3所小学1 070名2~3年级学生为研究对象,并于2016年和2017年开展随访调查。调查内容包括体格发育、青春期发育和HPA轴昼夜节律。收集清晨觉醒时、醒后30 min和晚上入睡时3个时点唾液样本,并计算HPA轴昼夜节律指标:皮质醇觉醒应答(CAR)、昼间皮质醇总分泌量及昼夜皮质醇斜率(DCS)。采用睾丸容积、乳房发育分别评价男女童青春期发育阶段。采用问卷调查收集出生日期、入睡与起床时间和每周体力活动等信息。采用非参数检验比较HPA轴昼夜节律基线各指标在基线、随访期及不同青春期发育进程中的差异。结果 随访期间,青春期发育启动组和持续发育组CAR值、CAR变化值均高于与持续未发育组,差异有统计学意义(CAR:Z值分别为8.551和4.680,均P<0.01;CAR变化值:Z值分别为4.079和2.700,均P<0.01);青春期启动组昼间皮质醇总分泌量高于持续未发育组,差异有统计学意义(Z=2.591,P=0.010)。与持续未发育组相比,DCS变化值在青春期启动组和持续发育组中下降明显,差异有统计学意义(Z=-2.450,Z=-2.151;均P<0.05)。昼间皮质醇总分泌量变化值与DCS在不同青春期发育进程组儿童中差异无统计学意义(昼间皮质醇总分泌量变化值:χ2=2.747,P=0.253;DCS:χ2=4.554,P=0.032)。结论 HPA轴昼夜节律指标与青春期发育有关,CAR、昼间皮质醇总分泌量随青春期发育进行而升高,昼间皮质醇差值随青春期发育而下降。
英文摘要:
      Objective To explore the developmental characteristics of circadian rhythms in hypothalamus-pituitary-adrenal (HPA) axis during puberty. Methods A total of 1 070 students from Grade 2-3 in 3 primary schools in Ma'anshan city, Anhui province, were selected for physical examination and circadian rhythm of HPA axis checked from 2015 to 2017. Saliva samples were collected at each of the following three time points:immediately upon wakening, 30 minutes after wakening and bedtime, with the index of circadian rhythm of HPA axis calculated, which including cortisol awake response (CAR), cortisol in puberty priming and diurnal cortisol slope (DCS). Testicular volume, palpation and visual inspection of breast development were used to assess the state of purbety development on boys and girls. Information on gender, date of birth, time to fall asleep, wake-up time and weekly physical activity were gathered through questionnaire survey. Non-parametric test was used to compare the differences of baseline, follow-up period and different adolescent developmental processes of each index on circadian rhythm of HPA axis. Results During the period of follow-up program and comparing with the continuous undeveloped group, CAR and the changes of CAR showed significantly increase, both in the puberty priming group and continuous development group, with statistically significant differences (CAR:Z=8.551, 4.680, respectively; P<0.01; the changes of CAR:Z=4.079, 2.700, respectively, P<0.01). There were no significant differences noticed in CAR and the changes of CAR between puberty priming group or continuous development group. The area under the curve (AUC) of cortisol in puberty priming group was slightly higher than that in the persistent undeveloped group (Z=2.591, P=0.010). Both the changes of daily cortisol slope (DCS) in puberty priming group and continuing developed group decreased significantly, when comparing with those in continuous undeveloped group (Z=-2.450, Z=-2.151; all P<0.05). There was no significant difference noticed in the changes of cortisol in puberty priming and DCS between different puberty development stages (the changes of AUC:χ2=2.747, P=0.253; DCS:χ2=4.554, P=0.032). Conclusions The indexes of circadian rhythm of HPA axis were associated with the development of puberty. Both the cortisol awakening response and the total amount of diurnal cortisol secretion showed an increase, along with the puberty development. The change of diurnal cortisol slope declined with the development of puberty.
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