促性腺激素释放激素类似物对特发性中枢性性早熟女童体质量指数及骨代谢标志物水平的影响

Effects of gonadotropin-releasing hormone analogues on body mass index and bone metabolic markers in girls with idiopathic central precocious puberty

目的探究促性腺激素释放激素类似物(GnRHa)对特发性中枢性性早熟(ICPP)女童体质量指数(BMI)及骨代谢标志物水平的影响。方法 选取2015年1月至2016年1月我院收治的ICPP女童100例为研究对象,为观察组,同期选取我院健康体检女童100例为对照组。观察组患儿均给予盐酸曲普瑞林进行治疗,治疗疗程1.5年。截至2018年6月,平均随访时间(1.1±0.3)年。记录观察组女童在治疗开始、结束及达到终身高时的年龄、骨龄、BMI、超重率及肥胖率。记录观察组患儿治疗前、后(2年)及对照组女童Ⅰ型前胶原氨基端肽(P1NP)、骨钙素N端中分子片段(N-MID)、β-胶原降解产物(β-CTX)水平。结果 观察组患儿治疗停止时的年龄、骨龄和BMI均高于治疗开始时,差异均有统计学意义(P<0.05);观察组患儿达到终身高时的年龄与骨龄均高于治疗开始时,差异均有统计学意义(P<0.05),而观察组患儿达到终身高时与治疗开始时BMI相近,差异无统计学意义(P>0.05);观察组患儿在达到终身高时的年龄与骨龄均高于治疗停止时,BMI低于治疗停止时,差异有统计学意义(P<0.05)。治疗前观察组患儿P1NP和N-MID水平显著大于对照组,差异有统计学意义(P<0.05);两组β-CTX水平比较,差异无统计学意义(P>0.05)。治疗后观察组P1NP和N-MID水平均显著低于治疗前,差异均有统计学意义(P<0.05);治疗后β-CTX水平与治疗前相比差异无统计学意义(P>0.05)。结论 对患有ICPP的女童使用GnRHa进行治疗可对患儿成骨细胞的过度亢进起到有效的抑制效果,且不会对破骨细胞的功能产生较大影响,虽然治疗过程中患者的BMI值虽然有所上升,但治疗结束后会恢复到正常水平。

Objective To investigate the effects of gonadotropin-releasing hormone analogue (GnRHa) on body mass index (BMI) and bone metabolism markers in girls with idiopathic central precocious puberty (ICPP). Methods Totally 100 ICPP girls admitted to our hospital from January 2015 to January 2016 were selected as the study group, and 100 healthy check-up girls in our hospital during the same period were selected as the control group. The observation group was treated with triptorelin hydrochloride for 1.5 years. Up to June 2018, the average follow-up time was (1.1±0.3) years. The age, bone age, BMI, overweight rate and obesity rate of the girls in the observation group at the beginning, end of treatment and at the time of reaching lifelong height were recorded. The levels of procollagen type I amino-terminal peptide(P1NP), osteocalcin N-terminal mid-molecular fragment(N-MID) and β-collagen degradation product(β-CTX) were recorded before and 2 years after treatment in the observation group and in the control group. Results The age, bone age and BMI at the end of treatment in the observation group were higher than those at the beginning of treatment, and the difference was statistically significant ( P <0.05);the age and bone age at reaching the lifelong height were higher than those at the beginning of treatment in the observation group( P <0.05), while BMI was similar( P >0.05). In the observation group, the age and bone age at the time of reaching lifelong height were higher than those at the time of discontinuation of treatment, while BMI was lower( P <0.05). Before treatment, the levels of P1NP and N-MID in the observation group were significantly higher than those in the control group( P <0.05), but there was no significant difference in the levels of β-CTX between the two groups ( P >0.05). After treatment, the levels of P1NP and N-MID in the observation group were significantly lower than those before treatment and the difference was statistically significant( P <0.05);after treatment, the level of β-CTX was not significantly different from that before treatment( P >0.05). Conclusion GnRHa can effectively inhibit the hyperactivity of osteoblasts in girls with ICPP, and has no significant effect on the function of osteoclasts. Although the BMI value of the patients increases during the treatment, it will return to normal level after the treatment.