促性腺激素释放激素类似物改善特发性中枢性性早熟女童成年身高及相关因素分析

Analysis on the effect of GnRHa on improving final adult height and related factors in girls with idiopathic central precocious puberty

目的观察促性腺激素释放激素类似物(GnRHa)治疗特发性中枢性性早熟(ICPP)女童改善成年身高(FAH)的疗效,并分析其相关影响因素。方法回顾性分析2009年5月-2011年7月南京中医药大学附属医院就诊的26例单独应用GnRHa治疗,并已达或接近FAH的ICPP女童生长发育资料。结果经GnRHa治疗(22.50±5.48)月,并随访(58.00±7.44)月,26例ICPP女童FAH为(161.50±4.41)cm,较治疗开始时预测成年身高(157.23±5.51)cm显著增高(P<0.01),身高净获(4.27±4.05)cm。治疗前、治疗终止时患儿体重指数(BMI)为(16.32±1.67)kg/m^2、(17.39±2.41)kg/m^2,达到FAH时BMI为(19.95±2.21)kg/m^2,均在与年龄相应的±1s范围。26例ICPP女童月经来潮年龄(12.5±0.7)岁。FAH的最终获得与停药时身高、初潮年龄呈正相关(P<0.01或<0.05),与停药时骨龄呈负相关(P<0.01)。结论 GnRHa对改善ICPP女童FAH有显著疗效,FAH的最终获得与停药时身高、停药时骨龄及初潮年龄相关,停药后患儿青春发育与正常儿童相似。

Objective To evaluate the effect of gonadotropin-releasing hormone analogues(GnRHa) on improving final adult height(FAH) in girls with idiopathic central precocious puberty(ICPP),and to analyze the related factors. Methods Data of 26 ICPP girls,who had been treated with GnRHa alone and had reached or approached their FAH in the affiliated hospital of Nanjing Unversity of traditonal Chinese medicine from May, 2009 to July,2011,were retrospectively analyzed. Results The 26 girls with ICPP were treated by GnRHa for(22.50±5.48)months,followed up for(58.0±7.44)months,and finally the mean FAH was(161.50±4.41)cm,significantly higher than the prediction of adult height before treatment [(157.23±5.51)cm,P<0.01].The net height gain was(4.27±4.05)cm.The body mass index(BMI) before treatment,at the end of treatment and after reaching FAH was(16.32±1.67)kg/m^2,(17.39±2.41)kg/m^2 and(19.95±2.21)kg/m^2 respectively,and all remained in the nomal range of age(±1s).The average menstrual age of 26 ICPP girls was(12.5±0.7)years old.The FAH was positively correlated with height when the medication stopped and menarche age(P<0.01 or <0.05),and negatively related to bone age when medication stopped(P<0.01). Conclusion GnRHa can significantly improve the final height in girls with ICPP,and the FAH is correlated with the height,bone age when the medication stopped,and menarche age.Moreover,youth development of children after medication stopped is similar to that of the normal children.