亮丙瑞林联合生长激素治疗中枢性性早熟女童的疗效及对骨代谢的影响

Clinical efficacy of leuprorelin combined with growth hormone in the treatment of central precocious puberty in girls and the effects on bone metabolism thereof

目的探讨亮丙瑞林联合生长激素治疗中枢性性早熟(CPP)女童的疗效及对骨代谢的影响。方法60例中枢性性早熟女童患儿,随机分为观察组和对照组,各30例。对照组患儿给予亮丙瑞林治疗,观察组给予亮丙瑞林联合生长激素治疗。比较两组患儿治疗前后生长指标[身高、骨龄(BA)、身高标准差积分(HtSDS)、预测成年身高(PAH)]、生长因子[血清类胰岛素样生长因子-1(IGF-1)]、骨代谢指标[Ⅰ型原胶原氨基N端前肽(PⅠNP)、骨钙素N端中分子片段(N-MID)、Ⅰ型胶原羧基端肽交联(β-CTX)]。结果治疗后,两组身高、BA比较差异均无统计学意义(P>0.05);治疗后,两组HtSDS、PAH均显著高于治疗前,且观察组HtSDS(-1.52±0.08)分和PAH(156.2±4.2)cm均高于对照组的(-1.83±0.11)分、(152.7±4.6)cm,差异有统计学意义(P<0.05)。治疗后,两组IGF-1水平均显著低于治疗前,但观察组IGF-1水平(252.76±21.38)ng/ml高于对照组的(165.39±18.22)ng/ml,差异具有统计学意义(P<0.05)。治疗后,两组β-CTX水平与本组治疗前及组间比较差异均无统计学意义(P>0.05);两组PⅠNP、N-MID水平均低于治疗前,且观察组PⅠNP(617.8±103.5)μg/L、N-MID(11.5±1.8)μg/L均低于对照组的(706.3±125.6)、(14.6±2.1)μg/L,差异有统计学意义(P<0.05)。结论生长激素联合亮丙瑞林治疗中枢性性早熟女童能显著改善其线性生长速度及PAH,调节骨代谢。

Objective To study the clinical efficacy of leuprorelin combined with growth hormone in the treatment of central precocious puberty(CPP)in girls and their effects on bone metabolism.Methods 60 girls with central precocious puberty were randomly divided into an observation group and a control group,with 30 cases in each group.The children in the control group were administered with leuprorelin;and the children in the observation group were administered with leuprorelin combined with growth hormone.The growth indexes[height,bone age(BA),height standard deviation score(HtSDS),predicted adult height(PAH)],growth factor[serum insulin-like growth factor-1(IGF-1)],bone metabolism indexes[amino N-terminal propeptide of procollagen typeⅠ(PⅠNP),N-terminal mid-fragment of osteocalcin(N-MID),carboxyl-terminal crosslinked propeptide of collagen typeⅠ(β-CTX)]were compared between the two groups before and after the treatment.Results The differences in height and BA between the two groups after the treatment were not statistically significant(P>0.05).After the treatment,HtSDS and PAH of the two groups were significantly higher than those before the treatment;the observation group had a HtSDS score of(-1.52±0.08)points and a PAH of(156.2±4.2)cm,which were higher than(-1.83±0.11)points and(152.7±4.6)cm of the control group,respectively;and the differences were statistically significant(P<0.05).After the treatment,IGF-1 levels of the two groups were significantly lower than those before the treatment;IGF-1 level of the observation group was(252.76±21.38)ng/ml,which was higher than(165.39±18.22)ng/ml of the control group;and the difference was statistically significant(P<0.05).After the treatment,theβ-CTX levels of the two groups had no statistical significance compared with that before treatment and the comparison between the two groups(P>0.05).After the treatment,the levels of PⅠNP and N-MID of the two groups were lower than those of this group before the treatment;the observation group had a PⅠNP level of(617.8±103.5)μg/L and a N-MID level of(11.5±1.8)μg/L,which were lower than(706.3±125.6)μg/L and(14.6±2.1)μg/L of the control group;all the differences were statistically significant(P<0.05).Conclusion In the treatment of central precocious puberty in girls,growth hormone combined with leuprorelin can significantly improve the linear growth rate and PAH and regulate bone metabolism.