生长激素与小剂量司坦唑醇联合应用对Turner综合征女孩生长和成年身高的影响

Combined treatment with recombinant human growth hormone and stanazolol improves growth and final adult height in girls with Turner＇s syndrome

40例Turner综合征（TS）女孩接受重组人生长激素（rhGH）与小剂量司坦唑醇治疗，开始治疗的年龄为（12．6±1．9）岁（8．8～16．2岁），观察年生长速率（GV）、参照健康中国女孩的身高标准差分值（HtSDS。）和参照未治疗中国Ts女孩的身高标准差分值（HtSDSTs）的动态变化。其中13例女孩疗程（2．9±1．2）年（2—5年），结束治疗后随诊至身高达最终成年身高（FAH）或接近FAH，开始雌激素替代年龄是（16．0±1．1）岁。40例Ts女孩经治疗HtSDS，逐年升高，治疗前为-4．2±1．0，治疗后的第1、2、3、4年和第5年分别为-3．4±1．0、-2．8±1．0、-2．4±O．8、-2．5±0．5和-2．3±0．3；HtSDSTs变化与HtSDSNnr相似。其中13例Ts女孩的FAH为（151．7±4．1）cm，显著高于治疗前预测成年身高（PAH，142．8±4．2）cm（P〈0．01），FAH改善了（8．9±2．8）cm；HtSDS。从治疗前-3．8±0．8提高到-1．6±0．8。研究结果表明对于年龄接近及大于9岁的Ts女孩，采用rhGH与小剂量司坦唑醇联合治疗能有效促进生长；在适当推迟雌激素诱导发育的情况下，促生长疗程≥2年能有效改善FAH。

Forty girls with Turner＇ s syndrome （ TS ）, aged （ 12.6 ± 1.9 ） years, were treated with daily subcutaneous injection of recombinant human growth hormone （ rhGH, 1.0 - 1.1 IU . kg-1 . w-l ） and oral stanozolol （0.02 -0.04 mg . kg-1. d-1 ） for 1 - 5 years. Growth velocity （ GV）, height standard deviation score （SDS） by reference of healthy Chinese girls （ HtSDSNor ） and height SDS by reference of untreated Chinese TS girls （ HtSDSTs ） were evaluated regularly. Of the forty girls studied, thirteen had discontinued the treatment after a mean duration of （2.9 ± 1.2 ） years when GV was less than 2 cm/year or when patients were satisfied with the achieved height. Final adult height （FAH） or near-final height, which was defined as the most recent available height after discontinuation of treatment, and the height gained in the thirteen girls were evaluated. Estrogen therapy was started at the age of（ 16.0 ± 1.1 ） years. HtSDSNor increased from -4.2 ± 1.0 to -3.4 ± 1.0 in the first year, and -2.8±1. 0, -2.4 s0. 8, -2.5 ±0.5, -2.3 ±0.3 respectively in the 2nd, 3rd, 4th, and 5th year. The change in HtSDSTs was similar to HtSDSNor. It was increased from 0. 1 ± 0.9 to 1.0±0.9 in the first year, and to 1.5 ± 0.8, 1.9 ± 0.6, 1.7 ±0.4, 1.7 ± 0.2 in the subsequent 4 years. The predicted adult height （PAH） in 13 girls was （ 142.8 ±4.2） cm before treatment. FAH was （ 151.7±4.1 ） cm, which was significantly higher than PAH （ P〈0.01 ） , and the mean height gain was （ 8.9± 2.8 ） cm （ 5.1 ±12 cm）. FAHSDSNor was increased to - 1.6 ±0.8 from - 3.8 ± 0.8. For girls with TS around 9 years of age, combined therapy with rhGH and low dosage of stanazolol may significantly increase growth velocity and improve final adult height.