促性腺激素释放激素激动剂联合维生素D对中枢性性早熟患儿骨龄及性激素水平的影响

Effect of GnRHa combined with Vitamin D on bone age and sex hormone level in children with central precocious puberty

目的 探讨促性腺激素释放激素激动剂(Gn RHa)联合维生素D对中枢性性早熟(CPP)患儿骨龄及性激素水平的影响,为临床优化治疗提供参考。方法 选取2020年1月~2022年6月浙江大学医学院附属第二医院临平院区收治的CPP患儿中满足条件的74例患儿作为研究对象,以随机数字表法将其分为单一GnRHa组、GnRHa联合维生素D组各37例。单一GnRHa组仅给予Gn RHa治疗,Gn RHa联合维生素D组行GnRHa联合维生素D治疗。两组均治疗12个月。比较两组治疗前后骨龄、生长速率、身高标准差积分(HtSDSBA)等生长发育指标及性激素水平与维生素D水平。结果 治疗后两组生长速率水平较治疗前降低,两组HtSDSBA水平较治疗前升高;组间比较,GnRHa联合维生素D组骨龄、生长速率明显低于单一GnRHa组,HtSDSBA明显高于单一GnRHa组,差异具有统计学意义(均P<0.05);治疗后两组卵泡刺激素(FSH)、黄体生成素(LH)与雌二醇(E_2)水平均明显低于治疗前,差异有统计学意义(P<0.05);组间比较,GnRHa联合维生素D组FSH、LH、E_2水平均明显低于单一GnRHa组,差异具有统计学意义(P<0.01);治疗后两组维生素D水平均明显低于治疗前,差异有统计学意义(P<0.05);组间比较,GnRHa联合维生素D组维生素D水平明显高于单一GnRHa组,差异具有统计学意义(P<0.01)。结论 维生素D在用于临床辅助GnRHa治疗CPP患儿时有助于改善其骨龄与生长情况,抑制性激素表达,同时降低Gn RHa治疗对患儿维生素D水平的影响,提高了治疗效果。

Objective To investigate the effects of gonadotropin-releasing hormone agonist(GnRHa)combined with vitamin D treatment on bone age and sex hormone levels in children with central precocious puberty(CPP),and provide references for optimizing clinical treatment.Methods A total of 74 CPP children who were admitted to Linping District of the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2020 to June 2022 and met the inclusion criteria were selected as the study subjects.They were randomly divided into a single GnRHa group and a GnRHa combined with vitamin D group,with 37 cases in each group.The children in the single GnRHa group received only GnRHa treatment for 12 months,while the children in the GnRHa combined with vitamin D group received GnRHa combined with vitamin D treatment for 12 months.The bone age,growth rate,height standard deviation score(HtSDSBA),and other growth and development indicators were compared between the two groups before and after treatment.The changes in sex hormone levels and vitamin D levels in the children before and after treatment were also compared.Results After treatment,the growth rate of children in both groups decreased compared with before treatment,and the HtSDSBA levels in both groups increased.Compared with the single GnRHa group,the bone age and growth rate of children in the GnRHa combined with vitamin D group were significantly lower,and the HtSDSBA was significantly higher(all P<0.05). After treatment,the levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),and estradiol(E2)in both groups were significantly lower than before treatment,with statistically significant difference(P<0.05). Compared with the single GnRHa group,the levels of FSH、LH and E2 in the GnRHa combined with vitamin D group were significantly lower(P<0.01). After treatment,the vitamin D levels in both groups were significantly lower than before treatment,with statistically significant difference(P<0.05). Compared with the single GnRHa group,the vitamin D level in the GnRHa combined with vitamin D group was significantly higher(P<0.01). Conclusion Vitamin D,when used as an adjunct to GnRHa treatment in children with CPP,can further improve bone age and growth,inhibit sex hormone expression,and reduce the impact of GnRHa treatment on vitamin D levels,thereby enhancing treatment effectiveness.