GnRHa对性早熟女童子宫卵巢及生长发育的影响

The Effect of Gn RHa on the Ovary and Growth of Precocious Puberty Girls

目的:探讨促性腺激素释放激素类似物(GnRHa)对性早熟女童子宫卵巢及生长发育的影响。方法:选取2018年5月-2019年12月在本院接受治疗的73例性早熟女童为研究对象,给予GnRHa治疗6个月,观察患者治疗前与治疗后血清性激素水平、子宫和卵巢容积、女童生长发育的变化,记录患儿的治疗有效率及不良反应率。结果:治疗前,患儿P-LH、P-FSH及E;水平分别为(24.14±3.25)mIU/ml、(13.28±4.65)mIU/ml和(32.15±2.14)pg/ml,与治疗后的(1.45±0.21)mIU/ml、(2.81±0.13)mIU/ml和(21.27±3.15)pg/ml对比,患儿在治疗后的P-LH、P-FSH及E;水平显著下降(t=61.835、19.230、24.410,P<0.001);治疗前,患儿左侧卵巢容积(2.86±0.61)ml,右侧卵巢容积(2.89±0.63)ml,子宫容积(4.25±1.31)ml,与治疗后的(1.87±0.53)、(2.01±0.55)、(2.16±0.45)ml对比,治疗后患儿子宫和卵巢容积显著减小(t=10.467、8.990、12.892,P<0.001);治疗前,患儿BMI及PAH为(16.85±0.76)kg/m^(2)和(147.59±7.68)cm,治疗后为(16.91±0.81)kg/m^(2)和(154.59±7.25)cm,治疗后患儿BMI与治疗前对比差异无统计学意义(t=0.462,P=0.645),但患儿PAH显著高于治疗前(t=5.663,P<0.001);73例患儿中有22例(30.14%)患儿症状显著改善,45例(61.64%)患儿症状有所改善,有6例(8.22%)患儿症状无明显改善。治疗过程中有2例患儿出现恶心呕吐反应,1例患儿注射部位皮肤出现片状红疹现象,不良反应发生率为4.11%,3例不良症状均未给予特殊处理,症状自行消退。结论:性早熟女童使用GnRHa可降低其性激素水平,缩小子宫和卵巢容积,减慢患儿的生长速率,治疗效果确切,安全性高,但应对患儿的体重进行控制。

Objective:To investigate the effects of Gonadotropin-releasing Hormone Analogues (GnRHa) on the uterus,ovaries and growth and development of girls with precocious puberty.Method:A total of 73 precocious puberty girls who were treated in our hospital from May 2018 to December 2019 were selected as the research subjects.GnRHa was given for 6 months of treatment.The serum sex hormone levels,uterus and ovaries of the patients were observed before and after treatment.Changes in volume and girls’ growth and development were recorded,and the effective rate of treatment and adverse reaction rates of the children were recorded.Result:Before treatment,the levels of P-LH,P-FSH and E;were (24.14±3.25) mIU/ml,(13.28±4.65) mIU/ml and (32.15±2.14) pg/ml,respectively.Comparing (1.45±0.21) mIU/ml,(2.81±0.13) mIU/ml and (21.27±3.15) pg/ml,the P-LH,P-FSH and E;levels of the child after treatment decreased significantly (t=61.835,19.230,24.410,P<0.001);before treatment,the volume of the left ovary (2.86±0.61) ml,the volume of the right ovary (2.89±0.63) ml,and the volume of the uterus (4.25±1.31) ml before treatment,and after treatment,the volume of the left ovary (1.87±0.53) ml,the volume of the right ovary (2.01±0.55) ml and the volume of the uterus (2.16±0.45) ml,the volume of the uterus and ovaries were significantly reduced after treatment (t=10.467,8.990,12.892,P<0.001);before treatment,the children’s BMI and PAH were (16.85±0.76) kg/m^(2) and (147.59±7.68) cm,after treatment they were (16.91±0.81) kg/m^(2) and (154.59±7.25) cm,there was no significant difference between BMI after treatment and before treatment (t=0.462,P=0.645),but the children’s PAH was significantly higher than before treatment (t=5.663,P<0.001);22 out of 73 children,the symptoms of 30.14% of the children improved significantly,the symptoms of 45 cases (61.64%) improved,and the symptoms of 6 cases (8.22%) did not improve significantly.During the treatment,2 cases of children had nausea and vomiting,and 1 case had flaky rash at the injection site.The incidence of adverse reactions was 4.11%.No special treatment was given to the 3 cases of adverse symptoms,and the symptoms resolved spontaneously.Conclusion:The use of GnRHa in precocious puberty girls can reduce their sex hormone levels,reduce the volume of the uterus and ovaries,and alleviate the growth rate of the children.The therapeutic effect is accurate and the safety is high.However,the weight of the children should be controlled.