应用注射用醋酸亮丙瑞林微球治疗的特发性中枢性性早熟女童血清胰岛素样生长因子1水平的变化及其与生长速度的关系

The alteration of serum insulin-like growth factor-1 level and the relationship with the growth rate during leuprorelin acetate microspheres for injection therapy in girls with idiopathic central precocious puberty

目的探讨应用注射用醋酸亮丙瑞林微球治疗的特发性中枢性性早熟(ICPP)女童血清胰岛素样生长因子1(IGF-1)水平的变化及其与生长速度的关系。方法回顾性分析2019年1月至2021年1月在北京积水潭医院儿科门诊诊断为ICPP的女童,从中筛选出仅应用注射用醋酸亮丙瑞林微球治疗且持续治疗1年以上的女童共42例。收集其治疗前、治疗6个月及1年后复查的病历资料,对比治疗前后身高、骨龄、骨龄预测终身高及IGF-1等指标变化,分析IGF-1水平变化与生长速度的关系。结果治疗6个月及1年后骨龄预测终身高高于治疗前[(158±3)、(159±4)cm比(156±4)cm],差异均有统计学意义(均P<0.05);治疗1年后患儿身高增长速度明显慢于治疗前、IGF-1年龄范围的标准差明显低于治疗前[(2.8±1.3)cm/6个月比(3.6±1.1)cm/6个月、-0.16(-0.42,0.42)比0.86(0.24,1.84)],差异均有统计学意义(均P<0.05)。治疗1年后患儿身高增长速度与骨龄进展速度的延缓程度及雌二醇下降程度呈正相关(r=0.483,P=0.020;r=0.424,P=0.049),与IGF-1的变化程度无明显相关性(r=0.405,P=0.061)。结论ICPP女童应用注射用醋酸亮丙瑞林微球治疗1年后身高增长速度及血清IGF-1水平均显著下降,身高增长速度与骨龄延缓控制程度及雌激素下降程度呈正相关,与IGF-1水平变化无明显相关性。

Objective To investigate the alteration of serum insulin-like growth factor-1(IGF-1)level and the relationship with the growth rate during leuprorelin acetate microspheres for injection therapy in girls with idiopathic central precocious puberty(ICPP).Methods A retrospective analysis was made on the girls diagnosed with ICPP in the pediatric clinic of Beijing Jishuitan Hospital from January 2019 to January 2021.A total of 42 cases were screened who were only treated with leuprorelin acetate microspheres for injection not less than 1 year.The medical records were collected before treatment,6 months after treatment and 1 year after treatment,and the changes of height,bone age,predicted final height of bone age,IGF-1 and other indicators were compared before and after treatment.The relationship between IGF-1 level changes and growth rate was analyzed.Results The predicted final height of bone age after 6 months and 1 year of treatment was significantly higher than that before treatment[(158±3),(159±4)cm vs(156±4)cm](both P<0.05).After 1 year of treatment,the growth rate of children's height was significantly lower than that before treatment,and the standard deviation of IGF-1 age range was significantly lower than that before treatment[(2.8±1.3)cm/6 months vs(3.6±1.1)cm/6 months,-0.16(-0.42,0.42)vs 0.86(0.24,1.84)],with statistically significant differences(both P<0.05).One year after treatment,the growth rate of children's height was positively correlated with the delay degree of bone age progression and the decline degree of estradiol(r=0.483,P=0.020;r=0.424,P=0.049),but not with the change degree of IGF-1(r=0.405,P=0.061).Conclusions After 1 year of treatment with leuprorelin acetate microspheres for injection in girls with ICPP,the growth rate of height and serum IGF-1 level decrease significantly.The growth rate of height is positively correlated with the delay control degree of bone age and the decline degree of estrogen,but not with the change level of IGF-1.