长效促性腺激素类似物治疗女童特发性中枢性性早熟的疗效

目的观察长效促性腺激素类似物(GnRHa)治疗女童特发性中枢性性早熟(ICPP)的疗效和副作用.方法对36例ICPP女童进行GnRHa治疗,观察治疗前后第二性征、子宫容积、卵巢容积、卵泡发育、骨龄与年龄比值(BA/CA)、体块指数(BMI)和生长速率的变化,采用Greulich-Pyle法评价骨龄,用Payley-Pinneau法预测成年预测身高(PAH),ELISA法测定血清抑制素A(INHA)和抑制素B(INHB),用化学发光法测定血清LH和FSH.结果①治疗3～6个月乳房均有缩小,其中12例Tanner Ⅱ期的女童治疗6个月乳房恢复到B1期;②治疗6个月子宫容积[(3.28±2.20)ml vs (1.27±0.69)ml]和卵巢容积[(3.62±1.94)ml vs (1.24±0.50)ml]均缩小,卵泡缩小甚至消失;血清INHA和INHB由治疗前Log(0.93±0.35)ng/L、Log(1.95±0.37)ng/L下降到Log(0.60±0.32)ng/L、Log(1.46±0.32)ng/L.③治疗1年,BA/CA由治疗前1.40±0.20下降到1.26±0.15;PAH由(149.12±4.04)cm升高到(152.84±3.72)cm,BMI治疗前后无明显变化(16.04±1.68 vs 15.93±1.69).结论GnRHa治疗能有效抑制性腺轴及第二性征的发育,延缓骨龄的成熟,改善预测成人身高,短期应用未见明显副作用.

Long-acting gonadotropin-releasing hormone analogue in treatment of idiopathic central precocious puberty in girls

OBJECTIVE: To investigate the efficacy and side-effects of long-acting gonadotropin-releasing hormone analogue (GnRHa) in treatment of idiopathic central precocious puberty (ICPP) in girls. METHODS: Thirty six ICPP girls were treated with GnRHa. The secondary sexual characteristics, uterus volume, ovary volume, follicle development, bone age/chronological age (BA/CA), predicted adult height (PAH), serum inhibitor A (INHA) and inhibitor B (INHB), body mass index (BMI) and growth rate were compared before and after treatment. Bone age was assessed using the Greulich-Pyle method, PAH was calculated by the Payley-Pinneau method, serum INHA and INHB were measured by ELISA, and serum LH and FSH were measured by chemoluminescence. RESULT: (1) Breast development was reduced after 3 to approximately 6 months of treatment, and no continued development were observed. In 12 girls the breast development returned from Tanner II to B1. (2) Both uterus and ovary volume were decreased after 6 months [(3.28 +/-2.20)ml comrade with (1.27 +/-0.69)ml and (3.62 +/-1.94)ml compared with (1.24 +/-0.50)ml, respectively]; the follicle was reduced or even disappeared; and the serum INHA and INHB were decreased from Log(0.93 +/-0.35)ng/L and Log(1.95 +/-0.37)ng/L to Log(0.60 +/-0.32)ng/L and Log(1.46 +/-0.32)ng/L, respectively. (3) BA/CA was decreased from 1.40 +/-0.20 to 1.26 +/-0.15; PAH was increased from (149.12 +/-4.04)cm to (152.84 +/-3.72)cm after one-year treatment; BMI showed no significant changes (16.04 +/-1.68 compared with 15.93 +/-1.69). CONCLUSION: GnRHa can effectively inhibit the development of sex gland and the secondary sexual characteristics, stabilize or delay bone maturation, improve the predicted adult height, and has no observed side-effects in the short-term treatment for ICPP girls.