GnRHa治疗真性性早熟过程中生长速度的相关因素分析  

Correlative analysis of growth velocity in girls with central precocious puberty during gonadotropinreleasing hormone analog therapy

作　　者：马华梅[1] 杜敏联[1] 李燕虹[1] 苏喆[1] 陈红珊[1] 古玉芬[1] 

机构地区：[1]中山大学附属第一医院儿科,广州510080

出　　处：《中华内分泌代谢杂志》2007年第5期388-391,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的分析中枢性性早熟(CPP)女孩接受促性腺激素释放激素类似物(GnRHa)治疗过程中线性生长速度(GV)的相关因素,以及影响两年GnRHa疗效的因素。方法将86例已接受GnRHa治疗满2年的CPP女孩治疗第2年中的生长速度(GY_(第2年))、2年GnRHa治疗对于改善成年身高的疗效(△PAH)与遗传靶身高、发病年龄、骨龄、年龄等参数进行相关分析及逐步回归分析。结果GnRHa治疗中GV呈逐年下降趋势,GV_(第2年)年与发病年龄、治疗开始和治疗第1年末的年龄、骨龄负相关(r分别为-0.37,-0.59,-0.57,-0.51和-0.52,均P<0.01);治疗开始的骨龄和治疗第1年末的年龄是独立影响GV_(第2年)的两个因素。△PAH与治疗开始的青春期病程、治疗两年骨龄增长和年龄增长的比值(△BA/△CA)负相关,与第1年GV(GV_(第1年))、GV_(第2年)、以及2年的平均GV正相关;△BA/△CA、GV(第1年)和GV_(第2年)是能独立影响△PAH的3个因素。结论GnRHa治疗后GV的减慢在一定程度上是由于治疗前过早接受雌激素、导致长骨干骺生长板过度老化的结果;CPP患儿宜早期治疗、最大程度减少因生长板过度老化所致生长潜力的丧失;而尽可能地抑制骨龄以及维持一定的GV是GnRHa疗效的两个重要保证。Objective To analyse the relative factors of the linear growth velocity （GV） in girls with central precocious puberty （CPP） during gonadotropin-releasing hormone analog （GnRHa） therapy, and to investigate the factors affecting the height gain during two-year GnRHa treatment. Methods In 86 girls aged （8.04 ＋ 1.28） years with CPP treated with GnRHa for more than 2 years, the data including target height, age of onset, pubertal course, chronological age, bone age, linear GV, serum estradiol level and mature index of vaginal smear were analyzed, then the correlations and stepwise regression were performed. Results During GnRHa therapy, GV decreased year by year. The GV in the second year（ GV2nd ） was negatively correlated with the age of onset, bone age （BA0, BA2 ） and chronologic age （CA0, CA2 ） at the onset and by the end of the first year of GnRHa therapy （r = - 0. 37, - 0. 59, - 0. 57, - 0. 51 and - 0. 52, respectively, all P 〈 0.01 ）. BA0 and CA2 werethe two variables being able to influence GV2 independently. The gain in the predicted final height during the two-year GnRHa treatment （APAH） was negatively correlated with pubertal course and the ratio of bone age increment to chronological increment （ABA/ACA）, and was positively correlated with GV （GV1st, GV2nd ） during the first year, second year of GnRHa treatment and the average GV in two years. △BA/△CA, GV1st, and GV2nd were 3 variables being able to influence independently the effect of two-year GnRHa treatment on final height gain. Conclusion The decreased GV during GnRHa therapy is due, at least in part, to premature growth plate senescence induced by the prior estrogen exposure. Girls with CPP need to be treated as early as possible for less loss of growth potential. Effective inhibition of bone maturation and maintenance of adequate linear GV are the two preconditions of GnRHa treatment in improving the final height for CPP.

关 键 词：青春期 早熟 女童 生长面 年龄测定 骨骼 促性腺激素释放激素 

分 类 号：R725.8[医药卫生—儿科]