GnRHa治疗对特发性中枢性性早熟女童肾上腺功能初现的影响  

Effects of gonadotropin-releasing hormone analogue treatment on adrenarche in girls with idiopathic central precocious puberty

作　　者：苏喆[1] 杜敏联[1] 李燕虹[1] 马华梅[1] 陈红珊[1] 陈秋莉[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》2011年第4期283-286,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的 通过随访特发性中枢性性早熟（ICPP）女童经促性腺激素释放激素类似物（GnRHa）治疗前、后阴毛发育情况和血硫酸脱氧表雄酮（DHEAS）水平,探讨肾上腺功能初现与性腺轴发育的关系.方法 对确诊为ICPP且按年龄判断血DHEAS的z分值超过正常上限（＋2 s）的49例女童在GnRHa治疗前后每3-6个月行性征检查,治疗后每年检测血DHEAS.平均随访（4.08＋0.83）年,其中16例随访至停药后1年.结果 治疗前阴毛发育2期（PH2）和阴毛发育3期（PH3）的达到年龄均小于正常[（8.07对11.16）岁,（8.82对12.40）岁],ICPP女童GnRHa受治期间阴毛发育进程显著慢于正常对照[PH2-PH3：（1.69对0.83）年;PH3-阴毛发育4期（PH4）：（1.64对0.60）年];同时也长于治疗前的自然进程[PH2-PH3：（1.69对0.88）年].乳房开始发育至阴毛萌出的间期亦然,ICPP治疗前后和正常对照分别为1.13、3.62和0.76年.在GnRHa治疗期间ICPP女童每年DHEAS Z分值呈逐年递减,停药后又显增.结论 大于6岁的性腺轴初现提前可诱致肾上腺功能初现提前,而GnRHa治疗在抑制性腺轴的同时也能延缓肾上腺功能发育的进程.Objective To explore the relationship between adrenarche and gonadarche.Methods Total 49 idiopathic central precocious puberty（ICPP）girls,whose serum dehydroepiandrosterone sulfate（DHEAS）Z scores for chronological age were higher than＋2 s at diagnosis.were enrolled.Physical examinations during pubertal stage were repeated at 3-6 months intervals,and serum DHEAS levels were monitored yearly within an average period of 4.08 years.Of them,16 girls were followed up until more than one year after discontinuation of gonadotropin-releasing hormone analogue（GnRHa）treatment.Results Before GnRHa treatment,these49 girls presented a younger average age at attainment of pubic hair stage2（PH2）and pubic hair stage3（PH3）than normal（8.07 years vs 11.16 years,8.82 years vs 12.40 years respectively）.During GnRHa treatment,the intervals between PH2 and PH3,PH3 and pubic hair stage4（PH4）,breast stage 2（B2）,and PH2 were longer than normal（1.69 years vs 0.83 years,1.64 years vs 0.60 years,and3.62 years vs 0.76 years respectively）.The intervals between PH2 and PH3,as well as B2 and PH2 during GnRHa treatment were also longer than that before GnRHa treatment（1.69 years/35 0.88 years,3.62 years vs 1.13 years respectively）.The serum DHEAS Z scores decreased during GnRHa treatment,and increased significantly after GnRHa cessation.Conclusion Gonadarche after age of 6-year-old may lead to earlier adrenarehe.GnRHa treatment might slow down the progression of adrenarche and suppress the hypothalamuspituitary-gonadal axis.

关 键 词：硫酸脱氢表雄酮 肾上腺功能初现 性腺功能初现 特发性中枢性性早熟 

分 类 号：R725.8[医药卫生—儿科]