目的 探讨促性腺激素释放激素类似物(GnRHa)治疗女童特发性中枢性性早熟(ICPP)对促生长素轴功能与生长速度关系的影响,为GnRHa治疗后出现的生长减速寻找新的治疗方法提供理论依据。方法 对接受GnRHa治疗的27例ICPP女童,观察在治疗开始以及治疗1年后其身高、骨龄、血清胰岛素样生长因子I(insulin-like growth factor-1,IGF-I)以及胰岛素生长因子结合蛋白3(IGFBP-3)等数据。依据她们的年龄分别计算身高、骨龄、IGF-I以及IGFBP3的标准差积分(SDS)。结果 ICPP患儿GnRHa治疗1年后,按实际年龄的身高SDS从1.03±0.74下降至0.83±0.73(P<0.001),按骨龄的身高SDS从-0.56±0.78增至-0.26±0.65(P<0.001)。治疗前后IGF-I SDS,IGFBP-3 SDS以及IGF-I/IGFBP-3差异无统计学意义(P>0.05)。与身高生长速度相关性最强的是提前的骨龄(R=0.291,P<0.05)。结论 ICPP患儿GnRHa治疗前后IGF-I、IGFBP-3均无明显改变,GnRHa可能是通过抑制IGF-I分泌轴之外的机制来影响身高生长速度。
Abstract
Objective To recognize the effects and relationship between somatotropin axis function and growth velocity in girls with idiopathic central precocious puberty (ICPP) treated with gonadotropin-releasing hormone analogue (GnRHa),and provide a theoretical basis for new treatments to cure growth deceleration after GnRHa therapy. Methods A total of 27 girls with ICPP treated with GnRHa were studied prospectively.Their height,bone age (BA),serum insulin-like growth factor-1 (IGF-I) and IGF binding protein-3 (IGFBP-3) concentrations at the beginning and the end of one year of GnRHa treatment were measured.The standard deviation scores (SDSs) of their height,BA,IGF-I,and IGFBP-3 concentrations according to their age at the beginning and the end of one year of GnRHa treatment were calculated. Results After one-year GnRHa treatment,height SDS for CA(HtSDSCA) significantly decreased from 1.03±0.74 to 0.83±0.73 (P<0.001),but height SDS for BA(HtSDSBA) increased from (-0.56±0.78) to (-0.26±0.65) (P<0.001).There was no significant change in serum IGF-I SDS,IGFBP-3 SDS,and IGF-I/IGFBP-3 ratio(P>0.05).The advanced BA was the factor most strongly correlated to the height velocity (R=0.291,P<0.05). Conclusions There is no significant change in serum IGF-I SDS,IGFBP-3 SDS,and IGF-I/IGFBP-3 ratio after GnRHa treatment.The height velocity affected by GnRHa treatment may due to other mechanism than suppression of the IGF-I secretory axis.
关键词
中枢性性早熟 /
促性腺激素释放激素类似物 /
促生长素轴 /
生长速度
Key words
central precocious puberty /
gonadotropin-releasing hormone analogues /
somatotropin axis /
growth velocity
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中华人民共和国卫生部.性早熟诊疗指南(试行)【卫办医政发(195)号】[J].中国儿童保健杂志,2011,19(4):390-392.
[2] Gillis D,Karavani G,Hirsch HJ,et al.Time to menarche and final height after histrelin implant treatment for central precocious puberty[J].J Pediatr,2013,163(2):532-536.
[3] 马华梅.儿童性早熟药物治疗进展[J].实用儿科临床杂志,2011,26(8):553-557.
[4] Yi KH.Serum IGF-1 and IGFBP-3 levels in central precocious puberty girls treated with gonadotropin releasing hormone agonist (GnRHa) [J].J Korean Soc Pediatr Endocrinol,2011,16(3):20-23.
[5] 叶义言.中国儿童骨龄评分法[M].北京:人民卫生出版社,2005:11-55.
[6] 李辉,季成叶,张亚钦,等.中国0～18岁儿童身高体重的标准化生长曲线[J].中华儿科杂志,2009,47(7):487-492.
[7] 许珊珊,顾学范,潘慧,等.儿童青少年血清胰岛素生长因子-1及胰岛素因子结合蛋白-3的正常参考值研究[J].临床儿科杂志,2009,27(12):1105-1110.
[8] 中华医学会儿科分会内分泌遗传代谢学组青春发育调查研究协作组.中国九大城市女性儿童第二性征发育和初潮年龄调查[J].中华内分泌代谢杂志,2010,26(8):669-675.
[9] Yum T,Lee S,Kim Y.Association between precocious puberty and some endocrine disruptors in human plasma[J].J Environ Sci Health A Tox Hazard Subst Environ Eng,2013,48(8):912-917.
[10] Poli F,Pizza F,Mignot E,et al.High prevalence of precocious puberty and obesity in childhood narcolepsy with cataplexy[J].Sleep,2013,36(2):175-181.
[11] Lee HS,Park HK,Ko JH,et al.Utility of Basal luteinizing hormone levels for detecting central precocious puberty in girls[J].Horm Metab Res,2012,44(11):851-854.
[12] Park HK,Lee HS,Ko JH,et al.The effect of gonadotrophin-releasing hormone agonist treatment over 3 years on bone mineral density and body composition in girls with central precocious puberty[J].Clin Endocrinol (Oxf),2012,77(5):743-748.
[13] 林小梅,文飞球,吴本清,等.性早熟女性患儿血清IGF-1和IGFBP-3质量浓度检测及临床价值[J].中国实用儿科杂志,2005,20(4):212-214.
[14] 马华梅,杜敏联.GnRHa对特发性中枢性性早熟女童生长的影响[J].中山大学学报:医学科学版,2003,24(2):156-160.
[15] Walvoord EC,Pescovitz OH.Combined use of growth hormone and gonadotropin-releasing hormone analogues in precocious puberty:theoretic and practical considerations[J].Pediatrics,1999,104(4Pt 2):1010-1014.
[16] Weise M,Flor A,Bames KM,et al.Determinants of growth during gonadotropin-releasing hormone analog therapy for precocious puberty[J].J Clin Endocrinol Metab,2004,89(1):103-107.
[17] Kim YJ,Lee HS,Lee YJ,et al.Multicenter clinical trial of leuprolide acetate depot (Luphere depot 3.75 mg) for efficacy and safety in girls with central precocious puberty[J].Ann Pediatr Endocrinol Metab,2013,18(4):173-178.
[18] Inman M,Hursh BE,Mokashi A,et al.Occurrence of slipped capital femoral epiphysis in children undergoing gonadotropin?releasing hormone agonist therapy for the treatment of central precocious puberty[J].Horm Res Paediatr,2013,80(1):64-68.
PDF(445 KB)
