蛋白同化类固醇激素对GnRHa治疗后中枢性性早熟患儿生长的影响  

Growth effect of stanazolol in girls with central idiopathic precocious puberty treated with GnRH analogue.

作　　者：朱顺叶[1] 陈红珊[2] 马华梅[2] 李燕红[2] 潘思年[1] 苏喆[2] 古玉芬[2] 杜敏联[2] 

机构地区：[1]中山大学附属第三医院儿科,广东广州510630 [2]中山大学附属第一医院儿科,广东广州510080

出　　处：《中国儿童保健杂志》2009年第1期51-53,共3页Chinese Journal of Child Health Care

摘　　要：【目的】前瞻分析中枢性性早熟（central precocious puberty，CPP）患儿在促性腺激素释放激素拟似物（gonadotropin releasing hormone agonist，GnRHa）治疗中出现生长减速时司坦唑醇（stanozolol，ST）对克服减速的疗效。【方法】分析特发性CPP并接受了曲普瑞林治疗的女性患儿30例，分3组，①单独GnRHa组；②GnRHa＋ST组；③GnRHa＋生长激素（growth hormone，GH）组。按生长速度、骨龄（boneage，BA）配对。达菲林50～100btg／kg，每隔28d一次。ST30ug／（kg·d），连续服用3个月后停3个月；GH剂量1U／kg．w，分6～7次，睡前皮下注射。比较研究前后生长速度、BA、按骨龄判断的身高标准差分值（HtSDsba）、预测成年身高（PAH）、按遗传靶身高的预测成年身高标准差分值（PAHSDSTHt）。【结果】①单独GnRHa组研究前后生长速度未见改变，GnRHa＋ST组和GnRHa＋GH组均较加药前生长速度加快；②单独GnRHa治疗的患儿研究期间HtSDSba未见明显改善，而经过ST、GH治疗后HtsDSba均明显改善。△HtSDSba组间比较，GnRHa＋ST组显著高于单独GnRHa组及GnRHa＋GH组，GnRHa＋GH组亦显著高于单独GnRHa组；③单独GnRHa治疗组PAH未见明显改善，而经过ST、GH治疗后PAH明显改善。△PAH组间比较，GnRHa＋ST组显著高于单独GnRHa组，GnRHa＋GH组高于单独GnRHa组，GnRHa＋ST组与GnRHa＋GH组比较无明显差异。[结论]GnRHa能抑制中枢性性早熟患儿骨龄的增长，但在治疗过程中可能出现生长减速；对骨龄相对较大的患儿，应用司坦唑醇能显著改善生长速度，提高预测成年身高。远期的对成年终身高影响尚需进一步观察。[Objective] To assess whether stanozolol may affect the height outcome in patients with CPP and growth deceleration during GnRHa treatment. [Methods] Ten girls with idiopathic CPP and severe growth deceleration during GnRHa treatment （triptorelin, 60~80 ug,/kg, in every 28 d） were treated with stanozolol combined therapy [received 0.03 mg/（kg · d）] of ST by mouth for 3 months, then observe 3 months ）. Their data were compared with those of 10 idiopathic CPP girls matched for duration of treatment, bone age and growth deceleration, treated with GnRHa alone and 10 idiopathic CPP girls treated with GH received 8 U/（kg - d） rhGH daily and GnRHa. Study duration sustained for 6 months. Comparisons of GV, BA, height SDS for bone age （HtSDSBA） and PAH were made between pre-eombined and post combined treatment, among the three groups. [Results] The growth velocity and HtSDSba of the patients treated with GnRHa plus stanozolol was significantly higher than pretreatment growth velocity. The PAH of the patients treated with GnRHa plus stanozolol was significantly higher than pretreatment predicted adult height and approaching target height. The PAH of patients treated with GnRHa plus GH was also higher than pretreatment predicted adult height and approaching target height. The APAH of the patients treated with GnRHa plus stanozolol and plus GH were significantly higher than that of patients treated with GnRHa alone. The pro-study and post-study PAH of patients treated with GnRHa alone was similar. No side effects were recorded in either group,of patients. [Conclusions] GnRHa can slow the maturation of hone, but in some patients, treatment with GnRHa induces an inappropriate deceleration of the growth rate with ensuing impaired final heights. Combined GnRHa and stanozolol therapy is a viable and low-cost treatment option for children with CPP and marked growth deceleration during treatment with GnRHa alone.

关 键 词：司坦唑醇 蛋白同化类固醇激素 生长 青春期 早熟 

分 类 号：R725.8[医药卫生—儿科]