特发性中枢性性早熟女童GnRHa治疗前后心理行为的变化

Psychological behavior of girls with idiopathic central precocious puberty before and after treatment with gonadotropin-releasing hormone analogue

目的:了解特发性中枢性性早熟(ICPP)女童心理行为改变与血清脱氢表雄酮(DHEA)、硫酸脱氢表雄酮(DHEAS)的关系,探讨长效促性腺激素类似物(GnRHa)在逆转或阻断ICPP女童不良心理行为中的作用。方法:由专人采用瑞文标准推理测验、艾氏儿童行为量表、自尊量表(SES)、躯体自信量表(BES)等对确诊ICPP女童和对照组女童进行心理行为的评估,用ELISA法检测DHEA、DHEAS水平,并对GnRHa治疗的ICPP女童进行DHEA、DHEAS及心理行为的随访。结果:1ICPP女童SES、BES的评分明显低于对照组(P<0.05);而艾氏儿童行为量表的抑郁、退缩、攻击性、体诉这4个因子的评分,ICPP组女童明显高于对照组(P<0.05);2ICPP组女童经GnRHa治疗12个月后,SES、BES得分有改善,治疗前、后比较差异有显著意义(P<0.05)。ICPP组女童GnRHa治疗前血清DHEA为Log(0.77±0.36)μg/L,明显高于对照组Log(0.28±0.22)μg/L(P<0.01);GnRHa治疗后3个月,DHEA和DHEAS浓度明显下降;而治疗12个月时,DHEA和DHEAS与治疗前比较差异无显著意义(P>0.05)。3ICPP女童SES的分值和BES中的体重关注、身体耐力2个分值与DHEA呈负相关(r分别为-0.492、-0.356、-0.202和-0.216,P均<0.05);而艾氏儿童行为量表的9个因子与DHEA无相关关系。结论:ICPP女童存在自尊程度低,自信心不足,且这种自尊程度和自信心不足随体内DHEA水平的增高而更加明显;性早熟女童更容易表现为抑郁、退缩、攻击性和好抱怨,但与体内DHEA水平变化无关;GnRHa治疗能不同程度地逆转ICPP女童的自尊程度低和自信心不足。

Objective： To observe the psychological behavior of girls with idiopathic central precocious puberty （ICPP） before and after treatment by gonadotropin-releasing hormone analogue （GnRHa）. Methods： Raven＇s Standard Progressive Matrices （SPM）, Achenbach＇s Child Behavior Checklist （CBCL）,Self-Esteem Scale （SES）,and Body-Esteem Scale （BES） were used to assess the psychological behavior in the ICPP girls before and after GnRHa treatment,as well as in control girls. The serum levels of dehydroepiandrosterone （DHEA） and dehydroepiandrosterone sulfate （DHEAS） were measured by ELISA before and after GnRHa treatment. Results： （1） The SES and BES scores in ICPP were significantly lower than those of controls （P〈0.05）. The CBCL scores in depressed,withdrawn,aggressive and somatic complaint assessment were significantly higher in ICPP group than those of control group. （2） The SES score,the body strength scores for BES 12 months after treatment were significantly higher than those pretreatment （P〈0. 05）. Serum DHEA levels in ICPP group and control group were Log （0. 77±0. 36）μg/L and Log （0.28 ±0.22）μg/L respectively, with a significant difference （P〈 0.01）. Serum DHEA and DHEAS of ICPP 3 months after treatment were decreased from Log （0. 83±0.35）μg/L and Log（2.27±0. 30）μg/L to Log（0.68±0.44）μg/L and Log（2.11±0.43） μg/L （both P〈0. 05）. The serum DHEA and DHEAS levels 12 months after treatment were Log （0. 78± 0. 30）μg/L and Log （2.40±0.34）μg/L, there was no significant difference before and after treatment（P〉0.05）. （3） The SES score,the weight concern and body strength scores for BES were negatively correlated with serum DHEA and DHEAS levels in precocious puberty girls （r=-0. 492,-0. 356,-0.202 and -0. 216,all P〈0.05）. The nine CBCL factors were not correlated with serum DHEA levels. Conclusions： Precocious puberty girls are prone to lower self-esteem and less confidence,which are correlated with the increase of serum DHEA levels. There is more frequency to be depressed, withdrawn, aggressive and complaining in these girls, however,which are not correlated with serum DHEA levels. GnRHa may reverse the problem of psychological behavior in ICPP girls.