GnRHa联合GH治疗中枢性性早熟或快速进展型青春期女孩有效性及安全性研究

Effectiveness and Safety of GnRHA Combined with GH in the Treatment of Central Precocious Puberty or Rapidly Progressing Adolescent Girls

目的研究促性腺激素释放激素激动剂(GnRHa)联合生长激素(GH)治疗中枢性性早熟(CPP)或快速进展型青春期女孩有效性及安全性。方法将深圳市妇幼保健院2018年6月至2019年12月收治的CPP或快速进展型青春期女孩128例纳入研究。将其按照治疗方式的差异分为GnRHa治疗组45例,GnRHa联合GH治疗组40例,对照组为未治疗组43例。分析各组患者治疗前后第1年、第2年、第3年预测成年终身高(PAH)、骨龄(BA)的身高标准差积分(HtSDSBA)、生长速率(GV)等方面的差异。结果①单用GnRHa组治疗后2年PAH(160.42±4.18)cm明显高于初始PAH(157.61±3.96)cm,且治疗第1年、治疗第3年的HtSDSBA明显高于治疗前,治疗第2年、治疗第3年的GV相较于治疗第1年明显降低(均P<0.05)。②GnRHa联合GH治疗组HtSDSBA在治疗前后第1年和第3年的身高SDS升高;治疗后2年PAH(157.13±4.76)cm,明显高于治疗前的(154.62±3.42)cm;治疗第1年、治疗第2年、治疗第3年GV均高于治疗前(均P<0.05)。③对照组2年后PAH(153.12±2.14)cm明显低于初始PAH(156.23±4.15)cm;GV在治疗第1年为(8.12±2.34)cm、第2年(5.32±4.23)cm、第3年(4.54±2.53)cm,差异有统计学意义(P<0.05)。④GnRHa治疗组未见明显不良反应,GnRHa联合GH治疗组仅出现2例亚临床甲低,且在1年后恢复正常。结论对于年龄>6岁;骨龄≤11.5岁;且骨龄>实际年龄1岁CPP或快速进展型青春期女孩应用GnRHa联合GH治疗成年身高改善效果显著,且安全性较高,值得临床推广应用。

Objective To study the efficacy and safety of gonadotropin-releasing hormone agonist(GnRHA)combined with growth hormone(GH)in the treatment of central precocious puberty(CPP)or rapidly progressing adolescent girls and to analyze.Methods A total of 128 adolescent girls with CPP or rapid progression type who were admitted to Shenzhen Maternal and Child Health Hospital from June 2018 to December 2019 were included.The patients were divided into GnRHA treatment group(n=45),GnRHA combined with GH treatment group(n=40)and untreated group(n=43)according to the difference of treatment methods.The difference of height standard deviation score(HTSDSBA)and growth rate(GV)in predicting adult lifetime height(PAH),bone age(BA)and bone age(BA)in 1,2 and 3 years before and after treatment was analyzed.Results The PAH at 2 years after treatment(160.42±4.18)cm was significantly higher than the initial PAH(157.61±3.96)cm,and the HTSDSbA at 1 and 3 years after treatment was significantly higher than that before treatment.The GV at 2 and 3 years after treatment was significantly lower than that at 1 year after treatment(all P<0.05).The height SDS of HTSDSBA in the GnRHA combined with GH treatment group increased at 1 and 3 years before and after treatment.Two years after treatment,the PAH(157.13±4.76)cm was significantly higher than that before treatment(154.62±3.42)cm.GV of the first,second and third year of treatment was higher than that before treatment(all P<0.05).After 2 years,the PAH(153.12±2.14)cm was significantly lower than the initial PAH(156.23±4.15)cm.GV was(8.12±2.34)cm in the first year of treatment,(5.32±4.23)cm in the second year and(4.54±2.53)cm in the third year of treatment,and the difference was statistically significant(P<0.05).No obvious adverse reactions were observed in the GnRHA treatment group,and only 2 cases of subclinical A hypoxia occurred in the GnRHA combined with GH treatment group,which returned to normal after 1 year.Conclusion GnRHA combined with GH has a significant effect for age>6 years;bone age≤11.5 years;and bone age>actual age 1 year CPP or rapidly progressive adolescent girls with high safety,and is worthy of clinical promotion and application.