联合应用促性腺激素释放激素类似物和生长激素治疗女童特发性中枢性性早熟的疗效观察

Effects of treatment on female idiopathic central precious puberty with gonodotrophine-releasing hormone analogue and growth hormone

【目的】评价促性腺激素释放激素类似物(GnRHa)联合生长激素(GH)治疗女童特发性中枢性性早熟(ICPP)的疗效。【方法】对生长速率(GV)减慢至可能损害预测成年身高(PAH)的60例ICPP女童采用GnRHa和GH联合治疗6个月。行LH释放激素(LHRH)激发试验和GH激发试验,所有患者均不缺乏GH。观察治疗前后第二性征和GV的变化,观测子宫大小、卵巢容积、骨龄与年龄比值(BA/CA)的变化,并评估预测成人身高。【结果】经治疗后第二性征的发育明显受到抑制,表现为乳房回缩、子宫、卵巢容积减小。LHRH激发试验显示LH、FSH峰值显著降低,骨龄成熟延缓。按BA的身高标准差分值(HtSDSBA)从治疗前-1.91±0.33升至-1.44±0.27(P<0.001)。按CA的身高标准差分值(HtSDSCA)从-0.31±0.12下降至-0.38±0.15。PAH由(153.4±1.1)cm升高到(156.0±1.0)cm(P<0.001)。GV由(3.81±1.3)cm增加至(8.63±3.5)cm。【结论】联合应用GnRHa和GH治疗ICPP,尤其是PAH明显落后的ICPP患者,能够有效抑制性腺轴及性腺发育,延缓骨龄成熟,改善预测成人终身高。

【Objective】 To assess the impact of treatment with Gonadotropin-releasing hormone（GnRH） analogs in combination with growth hormone（GH） in girls with idiopathic central precocious puberty（ICPP）.【Methods】 60 girls with ICPP whose growth velocity（GV） was so slowly that it impaired predicted adult height（PAH） were treated with recombinant human GH and GnRHa for 6 months.No patient showed classical GH deficiency.Before and after treatment,height,GV,and pubertal stage were observed,pelvic ultrasonic examination and X-ray bone age（BA） were detected,PAH was evaluated,and LH-releasing hormone（LHRH） stimulation test and GH stimulation test were performed.【Results】 The secondary sexual development was regressed with interruption of their menses,reduction of the size of uterus,ovaries and breasts.Plasma FSH and LH peaks after the LHRH test were suppressed.The decreased ratio of BA/CA（chronology age） showed the disrupted maturation of BA.PAH increased from（153.4±1.1）cm to（156.0±1.0）cm（P〈0.001） after 6 month treatment.The height SDS for BA（HtSDSBA） improved from-1.91±0.33 to-1.44±0.27（P〈0.001）,while height SDS for CA（HtSDSCA） from-0.31±0.12 to-0.38±0.15.【Conclusion】 In gilrs with ICPP especially who have a very short PAH,combination of GnRHa and GH effectively inhibits the gonadal axis and delays bone maturation,improve the predicted adult height.