促性腺激素释放激素类似物治疗中枢性性早熟女性患儿的远期效果及不良反应  

Long-term effects and adverse reactions of gonadotropin-releasing hormone analogues in treatment of girls with central precocious puberty

作　　者：张晓菲 罗静思[1] 唐晴[1] 钱家乐[1] 冯莹[1] 马琼 ZHANG Xiao-fei;LUO Jing-si;TANG Qing;QIAN Jia-le;FENG Ying;MA Qiong(Department of Pediatric Endocrinology and Hereditary-Metabolic Diseases,the Maternity and Child Health Care Hospital of Guangxi Zhuang Autonomous Region/the Children′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530002,China)

机构地区：[1]广西壮族自治区妇幼保健院/广西壮族自治区儿童医院儿童内分泌遗传代谢科,南宁市530002

出　　处：《广西医学》2022年第7期730-734,共5页Guangxi Medical Journal

基　　金：广西壮族自治区卫生健康委员会资助项目(Z20210245)。

摘　　要：目的探讨促性腺激素释放激素类似物(GnRHa)治疗中枢性性早熟(CPP)女性患儿的远期效果及不良反应。方法回顾性分析64例接受GnRHa治疗的CPP女性患儿的治疗资料和随访资料。记录治疗期间的年生长速率、骨龄及骨龄的身高标准差分值(HtSDS_(BA))、遗传靶身高、成年期终身高(FAH)、预测成人期终身高(PAH)、净获身高、超重/肥胖比例,以及随访终末时多囊卵巢综合征发生情况、月经情况等。结果(1)随治疗时间延长,患儿的年生长速率整体呈下降趋势(P<0.05),治疗后1年的年生长速率低于5 cm/年。(2)患儿的FAH为(160.98±4.95)cm,超过遗传靶身高,且高于治疗前和停药时的PAH(均P<0.05);停药时的HtSDS_(BA)较治疗前增加(P<0.05)。64例患者中,92.2%(59/64)的患儿FAH超过遗传靶身高,93.8%(60/64)的患儿治疗后身高有所追赶;随访终末时,64例患儿的净获身高为(9.45±4.47)cm。(3)小年龄治疗组的净获身高高于大年龄治疗组(P<0.05),但FAH差异无统计学意义(P>0.05)。(4)停药时的超重率较治疗前稍有增高,但差异并无统计学意义(P>0.05),而随访终末时的超重率较停药时降低(P<0.05);治疗前、停药时、随访终末时的肥胖率差异无统计学意义(P>0.05)。(5)随访终末时,64例患儿中,有4例(6.25%)明确诊断为多囊卵巢综合征。结论CPP女性患儿GnRHa治疗后身高获益显著,干预时间不同的患儿身高获益相似。GnRHa治疗可能会一过性增加CPP患儿的体重,但可能不会增加肥胖的发生风险;GnRHa治疗后CPP患儿有一定的多囊卵巢综合征发生风险,应严格掌握治疗适应证。Objective To investigate the long-term effects and adverse reactions of gonadotropin-releasing hormone analogues(GnRHa)in the treatment of girls with central precocious puberty(CPP).Methods The treatment data and follow-up data of 64 CPP girls receiving GnRHa treatment were analyzed retrospectively.The annual growth rate during the treatment,bone age,height standard-deviation score for bone age(HtSDS_(BA)),inherited target height,final adult height(FAH),predicted final adult height(PAH),net gain in height,and the proportion of overweight/obese cases,as well as the occurrence of polycystic ovarian syndrome and the condition of menstruation at the end of the follow-up,were recorded.Results(1)Overall,Children′s annual growth rate tended to decrease with the increasing treatment time(P<0.05),and one year after the treatment,the annual growth rate was under 5 cm per year.(2)Children′s FAH was 160.98±4.95 cm,which was higher than the inherited target height and also higher than the PAH before the treatment and at drug discontinuation(all P<0.05);HtSDS_(BA) at drug discontinuation was increased than that before the treatment(P<0.05).Among the 64 patients,92.2%(59/64)had a FAH greater than the inherited target height,and 93.8%(60/64)showed an increase in the body height after the treatment;at the end of the follow-up,the net gain in height of the 64 children was 9.45±4.47 cm.(3)The younger age treatment group yielded a largernet gain in height than the olderage treatment group(P<0.05),but FAH showed no statistically significant difference between the two groups(P>0.05).(4)The overweight rate at drug discontinuation showed a slight elevation over that before the treatment,but the difference was not statistically significant(P>0.05),whereas the overweight rate at the end of the follow-up was lower than that at drug discontinuation(P<0.05);the obesity rates before the treatment,at drug discontinuation and at the end of the follow-up showed no statistically significant difference(P>0.05).(5)At the end of the follow-up,

关 键 词：中枢性性早熟 促性腺激素释放激素类似物 身高获益 成年期终身高 不良反应 多囊卵巢综合征 

分 类 号：R585[医药卫生—内分泌] R459.1[医药卫生—内科学]