LHRH激发试验对性早熟女童GnRHa治疗的评估

Assessment of efficacy of GnRH analogs by LHRH stimulation test in children with central precocious puberty

目的：评价和监测促性腺激素释放激素类似物（GnRHa）治疗的有效性。方法30例经黄体生成素释放激素（LHRH）激发试验明确诊断的真性性早熟（CPP）女童，予GnRHa治疗6~24个月；治疗3个月及其后每6个月均行LHRH激发试验；比较LH峰值与临床发育受抑情况（包括发育分期、骨龄和生长速率）；评估LH峰值对GnRHa治疗的监测作用。结果共完成90次LHRH激发试验，仅7次有临床发育。治疗6个月后，30例女童的基础LH值为（0.48±0.20）IU/L，低于治疗前的（0.75±0.35）IU/L，差异有统计学意义（P=0.000）；基础LH值与LH峰值的相关系数为0.62（P=0.022）。LHRH激发试验LH峰值〈2 IU/L时，临床发育受抑情况最好（灵敏度85.7%，特异度100%）。结论基础LH值可用于评估CPP女童GnRHa治疗疗效。LHRH激发试验LH峰值〈2 IU/L可作为GnRHa治疗有效的指标。

Objective To evaluate and monitor the efifcacy of GnRH analogs （GnRHa） therapy. Methods Thirty girls with central precocious puberty diagnosied by LHRH stimulation test were treated with GnRHa for 6-24 months. The LHRH stimula-tion test were performed again at 3 months after initiation of therapy and then every 6 months during treatment. The relationship of peark LH and clinical suppressing pubertal （including Turner stage, bone age, grwoth speed） were compared. The monitor effect of peak LH to efifcacy of GnRHa were eveluated. Results Ninety LHRH stimulation tests were performed, only 7 cases were found to have clinical pubertal development. After 6 months treatment, the base LH level of thirty girls （0.48±0.20） IU/L was signiifcantly lower than that before the treatment （0.75±0.35 IU/L） （P=0.000）. The correlation coefifcient between base LH and peak LH was 0.62. The best correlation between clinical suppressing pubertal and LHRH stimulation test was achieved when peak LH was less than 2 IU/L （85.7%sensitivity, 100%speciifcity）. Conclusions Base LH value can be used in preliminary as-sessment of the efifcacy of GnRHa therapy for girls with central precocious puberty. The peak LH less than 2 IU/L can be as the indicator of treatment efifcacy.