长效促性腺激素类似物治疗女童特发性中枢性性早熟的疗效

Long-acting gonadotropin-releasing hormone analogue in treatment of idiopathic central precocious puberty in girls

目的：观察长效促性腺激素类似物（GnRHa）治疗女童特发性中枢性性早熟（ICPP）的疗效和副作用。方法：对36例ICPP女童进行GnRHa治疗，观察治疗前后第二性征、子宫容积、卵巢容积、卵泡发育、骨龄与年龄比值（BA／CA）、体块指数（BMI）和生长速率的变化，采用Greulich-Pyle法评价骨龄，用Payley—Pinneau法预测成年预测身高（PAH），ELISA法测定血清抑制素A（INHa）和抑制素B（INH。），用化学发光法测定血清LH和FSH。结果：①治疗3～6个月乳房均有缩小，其中12例TannerⅡ期的女童治疗6个月乳房恢复到B1期；②治疗6个月子宫容积[（3．28±2．20）ml vs （1．27±0．69）m1]和卵巢容积[（3．62±1．94）ml vs（1．24±0．50）m1]均缩小，卵泡缩小甚至消失；血清INHA和INHB由治疗前Log（0．93±0．35）ng／L、Log（1．95±0．37）ng／L下降到Log（0．60±0.32）ng／L、Log（1．46±0．32）ng／L。③治疗1年，BA／CA由治疗前1．40±0．20下降到1．26±0．15；PAH由（149．12±4．04）cm升高到（152．84±3．72）cm，BMI治疗前后无明显变化（16．04±1．68us15．93±1．69）。结论：GnRHa治疗能有效抑制性腺轴及第二性征的发育，延缓骨龄的成熟，改善预测成人身高，短期应用未见明显副作用。

Objective： To investigate the efficacy and side-effects of long-acting gonadotropin- releasing hormone analogue （GnRHa） in treatment of idiopathic central precocious puberty （ICPP） in girls. Methods： Thirty six ICPP girls were treated with GnRHa. The secondary sexual characteristics, uterus volume, ovary volume, follicle development, bone age/chronological age （BA/CA）,predicted adult height （PAH）,serum inhibitor A （INHA） and inhibitor B （INHu）, body mass index （BMI） and growth rate were compared before and after treatment. Bone age was assessed using the Greulich-Pyle method, PAH was calculated by the Payley-Pinneau method, serum INHa and INHu were measured by ELISA,and serum LH and FSH were measured by chemoluminescence. Results： （1） Breast development was reduced after 3 ± 6 months of treatment, and no continued development were observed. In 12 girls the breast development returned from Tanner Ⅱ to B1. （2） Both uterus and ovary volume were decreased after 6 months [（3.28±2.20）ml vs （1.27±0.69）ml and （3.62±1.94）ml vs （1.24±0.50）ml,respectively]; the follicle was reduced or even disappeared; and the serum INHAand INHuwere decreased from Log （0.93±0.35）ng/L and Log（1.95±0.37）ng/L to Log（0.60±0.32）ng/L and Log（1.46±0.32） ng/L, respectively. （3） BA/CA was decreased from 1.40±0.20 to 1.26± 0.15; PAH was increased from （149.12±4.04）cm to （152.84±3.72）cm after one-year treatment; BMI showed no significant changes （16.04±1.68 vs 15.93±1.69）. Conclusion： GnRHa can effectively inhibit the development of sex gland and the secondary sexual characteristics, stabilize or delay bone maturation,improve the predicted adult height,and has no observed side-effects in the short-term treatment for ICPP girls.