不同剂量促性腺激素释放激素类似物对性早熟女童下丘脑-垂体-性腺轴的影响  

Effect of Different Dose of Gonadotropin-Releasing Hormone Analog on Hypothalamic-Pituitary-Gonadal Axis of Girls with Precocious Puberty

作　　者：蔡锡顶[1] 李珍[1] 白敏[1] 朱蓓[1] 

机构地区：[1]浙江省舟山市妇幼保健院,浙江舟山316000

出　　处：《儿科药学杂志》2015年第7期18-21,共4页Journal of Pediatric Pharmacy

基　　金：浙江省舟山市科技局基金项目;项目编号2012C13031

摘　　要：目的:观察不同剂量促性腺激素释放激素类似物(Gn RHa)缓释剂对特发性中枢性性早熟(ICPP)或快速进展型早发育(EFP)女童下丘脑-垂体-性腺轴(HPGA)的影响。方法:26例ICPP和10例EFP女童预先给予Gn RHa(曲普瑞林或亮丙瑞林)每次100μg/kg,最大剂量3.75 mg皮下注射,每4周一次,治疗12周(给药3次)后按体质量分为低剂量组(体质量<30 kg)20例和高剂量组(体质量≥30 kg)16例。低剂量组Gn RHa剂量改为每次1.88 mg,高剂量组Gn RHa剂量改为每次80μg/kg,最大剂量3.75 mg,两组均根据LHRH激发试验LH峰值及临床受抑制情况调整剂量,每4周给药一次。随访1年,于治疗前及治疗后3、6、12个月复查LHRH激发试验,并观察发育抑制情况。结果:两组治疗前LH基值及峰值比较差异无统计学意义(P>0.05)。低剂量组治疗3个月后LH峰值均<2 IU/L,治疗6个月后有2例LH峰值>2 IU/L(及时调整剂量),治疗12个月后LH峰值均<2 IU/L;高剂量组治疗3个月后2例LH峰值>2 IU/L,予最大剂量3.75 mg治疗,仍有1例在治疗后6、12个月复查时LH峰值>2 IU/L,发育未完全抑制;两组其他女孩均表现为乳房肿块消退,骨龄增长受抑,生长速率降至发育前水平。结论:按患儿体质量应用不同剂量的Gn RHa治疗ICPP或EFP女童,均能有效抑制HPGA,提高患儿预测终身高。但在实际治疗过程中,需遵循个体化用药原则调整剂量。Objective： To observe the effect of different dose of gonadotropin-releasing hormone analog （GnRHa） on hypothalamicpituitary-gonadal axis （HPGA） of girls with central precocious puberty （ICPP） or early and fast puberty （EFP）. Methods： Thirty-six girls （26 cases ICPP and 10 cases EFP） were treated with GnRHa 100 μg/kg, maximum dosage was 3.75 mg. After 12 weeks of treatment, 36 girls were divided into two groups according to different weight. Low-dose group （weight less than 30 kg） ： 20 girls treated with GnRHa 1.88 mg. High-dose group （weight more than 30 kg） ： 16 girls treated with GnRHa 80μg/kg, maximum dosage was 3.75 mg. Adjusted the dosage according to the LH peak value of LHRH stimulation test and clinical inhibition. LHRH stimulation test was reviewed 3 months, 6 months, and 12 months after treatment. Results： LH basic value and peak value after LHRH stimulation test showed no significant difference between the two groups of girls before treatment. LH peak values were less than 2 IU/L in low-dose group after 3 months of treatment. At 6 months 2 girls had suppressed LH peak value （ 〈2 IU/L after LHRH stimulation）. Then two girls increased dose, at 12 months all of girls had suppressed LH peak value. Two girls in high-dose group had suppressed LH peak value at 3 months, two girls whose LH peak more than 2 IU/L, were given the max dose （3.75 mg）. After 6 months, 12 months, 1 girl had suppressed LH peak value. In the two groups, the mean Tanner stage manifested a significant shrinked, the ratio of bone age and chronological age significantly declined, the growth velocity （cm/year） decreased to prepubertal values, except a EFP girl in group B. Conclusion： Different dose of GnRHa according to different weight brought about consistent suppression of HPGA, increased predicted adult height. However, in specific treatment process, it still need to follow the principle of personalized medication.

关 键 词：促性腺激素释放激素类似物 曲普瑞林 亮丙瑞林 快速进展型早发育 中枢性性早熟 LHRH激发试验 

分 类 号：R725.8[医药卫生—儿科]