GnRH类似物对特发性中枢性性早熟女孩血IGF-Ⅰ和IGF结合蛋白-3水平的影响

Effect of gonadotropin-releasing hormone analogue on levels of serum insulin-like growth factor (IGF)-Ⅰ and IGF binding protein-3 in girls with idiopathic central precocious puberty

目的 研究特发性中枢性性早熟 (ICPP)女孩经促性腺激素释放激素类似物 (GnRHa)治疗后促生长素轴功能的改变和生长减速的原因。方法 比较 14例ICPP女孩GnRHa治疗开始时和治疗 6个月末的生长速度。于治疗前后行阴道涂片计算阴道上皮细胞成熟指数 (MI)、测定空腹血清E2 、胰岛素样生长因子 (IGF) Ⅰ、IGF结合蛋白 3(IGFBP 3)浓度 ,计算IGF Ⅰ /IGFBP 3,并进行比较。 13例年龄相匹配的健康青春前期女孩作为对照。结果 ICPP女孩经 6个月的GnRHa治疗后 ,生长速度较治疗开始时显著减慢〔治疗开始时 (8.2 3± 1.6 7)cm/年 ,治疗 6个月末 (6 .2 7± 1.5 4 )cm/年 ,P <0 .0 0 1〕 ;MI和血E2 浓度回复至青春前期水平。治疗开始时 ,ICPP女孩血IGF Ⅰ、IGFBP 3浓度和IGF Ⅰ /IGFBP 3〔(0 .4 9± 0 .16 )mg/L ,(4.91± 1.17)mg/L ,0 .10± 0 .0 3〕显著高于青春前期对照组〔(0 .2 1± 0 .14 )mg/L、(4.0 4± 0 .5 1)mg/L和 0 .0 5± 0 .0 2 ,P分别 <0 .0 0 1、<0 .0 5和 <0 .0 0 1〕。治疗 6个月末血IGF Ⅰ浓度〔(0 .4 9± 0 .15 )mg/L〕较治疗开始时差异无显著性 ;治疗 6个月末血IGFBP 3浓度〔(5 .2 9± 1.2 4 )mg/L〕较治疗开始时有增加趋势但差异无显著性 ;治疗 6个月末血IGF Ⅰ /IGFBP 3(0 .0 9± 0 .

Objective To recognize the changes in the somatotropin axis function in girls with idiopathic central precocious puberty (ICPP) treated with GnRH analogue (GnRHa) and to probe into the cause of growth velocity reduction during GnRHa treatment. Methods Fourteen girls with ICPP were studied. Their growth velocities at the beginning and the end of 6th month of GnRHa treatment were observed. Maturation indexes (MI) were got from vaginal smears, and serum E 2, insulin like growth factor (IGF Ⅰ), IGF binding protein 3 (IGFBP 3) concentrations were determined and IGF Ⅰ/IGFBP 3 calculated at the beginning and the end of 6th month of GnRHa treatment. The controls were 13 age matched healthy prepubertal girls. Results After 6 month GnRHa treatment, the growth velocity reduced significantly from (8.23±1.67)cm/y to (6.27±1.54)cm/y (P<0.001). MI and serum E 2 concentration returned to prepubertal level. At the beginning of GnRHa treatment, serum IGF Ⅰ, IGFBP 3 and IGF Ⅰ/IGFBP 3 in ICPP girls 〔(0.49±0.16)mg/L, (4.91±1.17)mg/L, 0.10±0.03〕 were all markedly higher as compared with the controls 〔(0.21±0.14)mg/L,(4.04±0.51)mg/Land0.05±0.02,P<0.001, 0.05 and 0.001 respectively〕. After 6 month GnRHa treatment, serum IGF Ⅰ and IGFBP 3 levels remained high, moreover, serum IGFBP 3 tended to increase but insignificantly 〔(5.29±1.24)mg/L〕. Serum IGF Ⅰ and IGF Ⅰ/IGFBP 3 remained unchanged 〔(0.49±0.15)mg/L and (0.09±0.02), respectively〕. Conclusion GnRHa slows down growth relocity in girls with ICPP, which does not relate to the changes of blood free IGF Ⅰ concentration.