GnRHa联合rhGH治疗对特发性中枢性性早熟女童成年终身高的影响

The effect of GnRHa combined with rhGH treatment on adult height in girls with idiopathic central precocious puberty

目的评价促性腺激素释放激素类似物(GnRHa)联合重组人生长激素(rhGH)对特发性中枢性性早熟(ICPP)女童成年终身高改善的效果及影响因素。方法回顾性分析2015年1月至2019年12月在湖南省儿童医院儿童保健所就诊,诊断为特发性中枢性性早熟并接受药物治疗已达到成年身高的60例ICPP女童,根据有无联用rhGH分为GnRHa组和GnRHa+rhGH组,分析骨龄(BA)/年龄(CA)、性激素、生长速率(GV)、预测成年身高(PAH)、成年终身高(FAH)、身高获益(FAH-PAH)、骨龄评估身高标准差积分(HtSDSBA)等指标变化。多重线性回归分析ICPP儿童身高获益的影响因素。结果60例ICCP女童药物治疗后性激素的峰值、比值和BA/CA比值均下降,差异均有统计学意义(均P<0.05)。两组患者第二年生长速率(GV2)比第一年生长速率(GV1)降低,差异有统计学意义(均P<0.05),两组FAH-PAH和△HtSDSBA比较差异有统计学意义(t=4.056,P<0.001,t=-6.238,P<0.001)。Pearson相关分析结果,与FAH-PAH相关的指标有CA(r=-0.477,P<0.01)、总治疗周期(r=0.441,P<0.01)、治疗前PAH(r=-0.533,P<0.01)、治疗后HtSDSBA(r=0.271,P<0.05)。以身高获益为因变量进行线性回归分析显示治疗前PAH(β=-0.674,t=-8.713,P<0.001)和治疗后HtSDSBA水平(β=4.362,t=6.223,P<0.001)是ICPP女童身高获益的独立影响因素,治疗前PAH水平越低和治疗后HtSDSBA越高,身高获益越大。结论GnRHa联合rhGH治疗或GnRHa治疗均能改善ICCP女童的成年身高,但联合用药身高获益更好,对于PAH严重受损女童可优先考虑GnRHa联合rhGH治疗。

Objective To evaluate the effect and influencing factors of gonadotropin-releasing hormone analog(GnRHa)combined with recombinant human growth hormone(rhGH)on the improvement of adult height in girls with idiopathic central precocious puberty(ICPP).Methods A retrospective analysis was conducted on 60 girls with ICPP who were diagnosed with idiopathic central precocious puberty and received drug treatment at the Children′s Healthcare Institution of Hunan Children′s Hospital from January 2015 to December 2019.They were divided into GnRHa group and GnRHa+rhGH group based on the presence or absence of combined rhGH.Changes in bone age(BA)/age(CA),sex hormones,growth rate(GV),predicted adult height(PAH),year-end height(FAH),height benefit(FAH-PAH),and bone age assessment height standard deviation score(HtSDSBA)were analyzed.Multiple linear regression analysis was conducted on the influencing factors of height benefits in children with ICPP.Results After drug treatment,the peak value,ratio,and BA/CA ratio of sex hormones in 60 ICCP girls all decreased,and the differences were statistically significant(all P<0.05).The second year growth rate(GV2)of the two groups of patients decreased compared to the first year growth rate(GV1),and the difference was statistically significant(all P<0.05).There was a statistically significant difference in FAH-PAH and△HtSDSBA between the two groups(t=4.056,P<0.001,t=-6.238,P<0.001).Pearson correlation analysis results showed that the indicators related to FAH-PAH included CA(r=-0.477,P<0.01),total treatment period(r=0.441,P<0.01),pre-treatment PAH(r=-0.533,P<0.01),and post-treatment HtSDSBA(r=0.271,P<0.05).Linear regression analysis with height benefit as the dependent variable showed that pre-treatment PAH(β=-0.674,t=-8.713,P<0.001)and post-treatment HtSDSBA levels(β=4.362,t=6.223,P<0.001)were independent influencing factors of height benefit in girls with ICPP.The lower the pre-treatment PAH level and the higher the post-treatment HtSDSBA,the greater the height benefit.Conclusions GnRHa combined with rhGH treatment or GnRHa treatment can improve adult height in ICCP girls,but the combination therapy has better height benefits.For girls with severe PAH damage,GnRHa combined with rhGH treatment should be prioritized.