单用促性腺激素释放激素类似物及联合重组人生长激素治疗对月经初潮后特发性中枢性性早熟女童身高的影响  

Effect of GnRHa alone and rhGH combined treatment on height of children with idiopathic central precocious puberty in girls after menarche

作　　者：王淑琴 薛颖 高怡青 韩晶晶 李婉丽 王培 丁兰 WANG Shuqin;XUE Ying;GAO Yiqing;HAN Jingjing;LI Wanli;WANG Pei;DING Lan(Department of Endocrinology and Metabolism,he Affiliated Xuzhou Children's Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China;Department of Nursing,The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属徐州儿童医院内分泌遗传代谢科,江苏徐州221000 [2]徐州医科大学附属徐州儿童医院护理部,江苏徐州221000

出　　处：《安徽医药》2024年第8期1650-1655,共6页Anhui Medical and Pharmaceutical Journal

基　　金：徐州市卫生健康委科技项目面上项目(XWKYHT20200033)。

摘　　要：目的探讨促性腺激素释放激素类似物(GnRHa)联合重组人生长激素(rhGH),单用GnRHa治疗对有月经初潮的特发性中枢性性早熟(ICPP)女童身高的影响。方法回顾性分析2014年1月至2020年12月于徐州医科大学附属徐州儿童医院儿童生长发育门诊就诊76例有月经初潮的ICPP女童为研究对象,根据治疗方案分为治疗对照组(n=22),单用GnRHa治疗组(n=22)和GnRHa联合rhGH治疗组(n=32),随访观察至接近成年终身高(near final adult height,NFAH),比较三组病儿NFAH、身高净生长(ΔHt)、遗传增高(NFAH-遗传身高)。结果对照组、GnRHa组、联合用药组三组就诊基线身高、体质量、身体质量指数(BMI)、骨龄、遗传靶身高差异无统计学意义(P>0.05),随访NFAH分别(158.27±3.63)cm、(159.61±3.91)cm、(162.61±3.34)cm,ΔHt分别(12.66±3.54)cm、(13.49±3.06)cm、(16.79±3.17)cm,遗传增高分别(−2.32±3.82)cm、(0.16±3.46)cm、(3.52±4.62)cm,三组间均差异有统计学意义(P<0.05),其中联合用药组与GnRHa组、对照组比较均差异有统计学意义(P<0.05);GnRHa组和对照组在遗传增高方面差异有统计学意义(P<0.05),在NFAH、ΔHt方面比较均差异无统计学意义(P>0.05)。结论对已有月经初潮的ICPP女孩,GnRHa联合rhGH治疗,可改善NFAH,但需权衡治疗成本及身高获益,临床应谨慎推荐,单用GnRHa治疗不改善NFAH,可改善遗传增高。Objective To investigate the effect of recombinant human growth hormone(rhGH)combined with gonadotropin-releasing hormone analogs(GnRHa),GnRHa therapy alone on the improvement of height in idiopathic central precocious puberty(ICPP)girls with menarche.Methods Retrospective analysis was performed on 76 ICPP girls with menarche from January 2014 to December 2020 who visited the Child Growth and Development Clinic from the Affiliated Xuzhou Children's Hospital of Xuzhou Medical University.According to the treatment,the children were divided into untreated control group(n=22),GnRHa alone treatment group(n=22)and GnRHa combined with rhGH treatment group(n=32).Near final adult height(NFAH),net growth of height(ΔHt)and genetic increase(NFAH-genetic height)were compared among the three groups.Results There were no statistically significant differences in baseline height,BMI,bone age and genetic target height among the three groups(P>0.05).In the control group,GnRHa group and the combined treatment group,NFAH were(158.27±3.63)cm,(159.61±3.91)cm,(162.82±3.53)cm.ΔHt were(12.66±3.54)cm,(13.49±3.06)cm,(16.79±3.17)cm and the genetic increase were(−2.32±3.82)cm,(0.16±3.46)cm,(3.52±4.62)cm,respectively.The differences were statistically significant among the three groups(P<0.05).There were statistical significance between the combination group and the other two groups(P<0.05).There was statistical difference in genetic increase between GnRHa group and control group(P<0.05),but no statistical difference in NFAH andΔHt group(P>0.05).Conclusions For ICPP girls with menarche,GnRHa combined with rhGH treatment can improve NFAH.However,the treatment cost and height benefit should be weighed,and clinical recommendation should be cautious.GnRHa alone can not improve the NFAH,but can improve the genetic height.

关 键 词：青春期 早熟 女童初潮 特发性中枢性性早熟 促性腺激素释放激素类似物 重组人生长激素 接近成年终身高 

分 类 号：R725.8[医药卫生—儿科]