GnRHa治疗对特发性中枢性性早熟和快速进展型早发育儿童的远期影响  

Long-term effects of GnRHa on central precocious puberty or early and fast puberty children

作　　者：马晓宇[1] 倪继红[1] 杨露露[1] 张莉丹 肖园[1] 董治亚[1] 陆文丽[1] 王伟[1] 王德芬[1] Ma Xiaoyu;Ni Jihong;Yang Lulu;Zhang Lidan;Xiao Yuan;Dong Zhiya;Lu Wenli;Wang Wei;Wang Defen(Department of Pediatrics,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院儿内科,200025

出　　处：《中华内分泌代谢杂志》2020年第1期58-62,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨促性腺激素释放激素类似物(GnRHa)长期治疗对中枢性性早熟(CPP)和快速进展型早发育(EFP)患儿终身高获益、性腺功能、体重指数(BMI)等远期影响,探讨身高获益的影响因素及早期预判指标。方法随访GnRHa治疗2年以上达终身高的50例CPP及44例EFP患者(女性80例,男性14例),检测治疗前、停治时及达终身高时身高、骨龄、BMI、促性腺激素、子宫卵巢容积(女)、睾丸容积(男)等参数,跟踪女性停药后月经、男性遗精等远期影响。结果(1)女孩:终身高获益GnRHa+生长激素(GH)组较GnRHa治疗组高[(10.69±5.73)cm对(7.42±5.76)cm,P<0.05],初治时身高受损>5 cm比≤5 cm组获益多[(10.65±3.32)cm对(6.51±3.40)cm,P<0.01];超重/肥胖比例初治、停治、达终身高时有减无增。血清LH水平、子宫卵巢容积停治时较治疗前明显下降,停治后半年至1年明显增加;停药后3年100%女孩出现初潮,3年内95%周期达规律。(2)男孩:身高获益GnRHa+GH组与GnRHa治疗组分别为(8.78±5.2)和(7.99±4.82)cm,血清LH水平、睾丸容积停治时较治疗前明显下降,停治后半年至1年明显增加。结论女孩CPP和EFP患儿经GnRHa治疗能明显改善终身高,身高受损严重者身高获益好,可作为身高获益的预判指标。Objective To investigate the long-term effects of GnRHa treatment on final height gain,gonadal function,and body mass index(BMI)in children with central precocious puberty(CPP)or early and fast puberty(EFP),and to explore the influencing factors of height gain and early predictors.Methods Fifty patients with CPP and 44 patients with EFP who were treated with GnRHa for more than 2 years were enrolled(80 females and 14 males).Body height,bone age,BMI,gonads hormone,uterus and ovarian volumes(female),testicular volume(male),and other parameters before and after treatment were measured.Results(1)For girls:GnRHa plus GH treatment gained more final height compared with GnRHa treatment[(10.69±5.73)cm vs(7.42±5.76)cm,P<0.05].Height lost>5cm at the initial treatment benefited much more for the final height compared with height lost<5cm[(10.65±3.32)cm vs(6.51±3.40)cm,P<0.01].The proportion of overweight/obesity decreased when reaching the final height compared with the initial treatment and stopping the treatment.Serum LH level,uterine and ovarian volume were significantly decreased after stopping treatment compared with before treatment,and increased half a year to 1 year after stopping treatment.100%of girls had menarche and 95%reached the regular cycle 3 years after stopping treatment.(2)For boys:GnRHa plus GH treatment and GnRHa treatment gained height by(8.78±5.2)and(7.99±4.82)cm,respectively.Serum LH level and testicular volume were significantly decreased after stopping treatment as compared with those before treatment,and increased for half a year to 1 year after stopping treatment.Conclusion GnRHa treatment can significantly improve the final height for girls with CPP and EFP.The patients with more height lost could gain more height,which can be used as a predictor of height gain.

关 键 词：促性腺激素释放激素类似物 中枢性性早熟 快速进展型早发育 远期影响 

分 类 号：R725.8[医药卫生—儿科]