环境内分泌干扰物与性早熟的关系

Relationship between Environmental Endocrine Disruptors and Precocious Puberty

摘要: 性早熟(Precocious Puberty, PP)指女孩7.5岁前出现乳房发育或10岁前出现月经初潮，男孩9岁前出现睾丸增大的内分泌疾病。性早熟对儿童身心健康构成严重威胁，其主要危害体现在：导致骨骺提前闭合，影响最终成年身高；引发焦虑、自卑等心理与社会适应问题；并显著增加未来罹患肥胖、胰岛素抵抗及多囊卵巢综合征等代谢与生殖系统疾病的风险。近年来其发病率呈显著上升趋势，我国现有约53万性早熟儿童，且以每年3%~5%的速度递增。尽管遗传因素及日益增长的肥胖率可能与此有关，但环境因素的作用亦不容忽视。特别是广泛存在的内分泌干扰物(Endocrine Disrupting Compounds, EDCs)被认为可能与青春期启动提前的趋势相关。既可模拟或拮抗内源性激素的受体结合活性，又能干扰激素的合成、代谢、转运及清除过程，这些多重机制共同导致内分泌系统的精细调控失衡，从而引发一系列生理病理改变。本文综述了动物和人类研究的现有证据，这些证据表明环境中的环境内分泌污染物(EDCs)可能造成儿童性早熟。

Abstract: Precocious Puberty (PP) refers to an endocrine disease in which girls have breast development before 7.5 years old or menarche before 10 years old, and boys have testicular enlargement before 9 years old. Precocious puberty poses a serious threat to children’s physical and mental health. Its main hazards are as follows: leading to early closure of the epiphysis and affecting the final adult height; it causes psychological and social adaptation problems such as anxiety and inferiority; it also significantly increases the risk of metabolic and reproductive system diseases such as obesity, insulin resistance and polycystic ovary syndrome in the future. In recent years, its incidence has shown a significant upward trend. There are about 530,000 children with precocious puberty in China, and it is increasing at a rate of 3%~5% per year. Although genetic factors and the increasing obesity rate may be related to this, the role of environmental factors cannot be ignored. In particular, the widespread presence of endocrine disrupting compounds (EDCs) is thought to be associated with an earlier onset of puberty. It can not only simulate or antagonize the receptor binding activity of endogenous hormones, but also interfere with the synthesis, metabolism, transport and clearance of hormones. These multiple mechanisms together lead to the imbalance of fine regulation of the endocrine system, which leads to a series of physiological pathology.