Massa G, Heinrichs C, Verlinde S, Thomas M, Bourguignon J P, Craen M, François I, Du Caju M, Maes M, De Schepper J
Department of Pediatrics, Bruxelles, Belgium.
J Clin Endocrinol Metab. 2003 Sep;88(9):4168-74. doi: 10.1210/jc.2002-022040.
Although it has been well established that GH treatment increases final height (FH) in girls with Turner syndrome (TS), the optimal ages to start GH therapy and introduce estrogens for pubertal induction have not been defined. We evaluated retrospectively the influence of the age at onset of GH treatment and age at onset of puberty on FH of 186 adult TS women treated during childhood with GH. Puberty started spontaneously in 38 patients, and it was induced in 148 girls with ethinyl estradiol (mean +/- SD starting dose, 66 +/- 32 ng/kg.d). Patients with spontaneous or induced puberty were divided into quartiles on the basis of age at initiation of GH treatment (3-10, 10-12, 12-14, and 14-19 yr). FH was 151.7 +/- 6.0 cm; there were no FH differences between patients with induced or spontaneous puberty, nor were there differences between the age quartiles. Puberty started earlier in the girls with spontaneous puberty than in those with induced puberty (12.4 +/- 1.3 yr vs. 14.5 +/- 1.9 yr; P < 0.0001). The age at onset of puberty was not related to FH. Pubertal growth was 15.4 +/- 4.6 cm in the girls with spontaneous puberty and 8.6 +/- 4.3 cm in the girls with induced puberty (P < 0.0001). We conclude that GH treatment results in a significant increase in FH in most TS girls. Under the conditions of GH treatment and induction of puberty that we have used, the age at start of GH treatment was not related to FH; in addition, late or delayed induced or spontaneous puberty did not affect FH.
虽然已有充分证据表明生长激素（GH）治疗可增加特纳综合征（TS）女孩的最终身高（FH），但开始GH治疗以及引入雌激素进行青春期诱导的最佳年龄尚未确定。我们回顾性评估了儿童期接受GH治疗的186例成年TS女性中，GH治疗起始年龄和青春期起始年龄对FH的影响。38例患者青春期自然启动，148例女孩使用乙炔雌二醇诱导青春期（平均±标准差起始剂量，66±32 ng/kg.d）。根据GH治疗起始年龄（3 - 10岁、10 - 12岁、12 - 14岁和14 - 19岁）将自然或诱导青春期的患者分为四分位数。FH为151.7±6.0 cm；诱导或自然青春期的患者之间FH无差异，年龄四分位数之间也无差异。自然青春期的女孩比诱导青春期的女孩青春期开始得更早（12.4±1.3岁 vs. 14.5±1.9岁；P < 0.0001）。青春期起始年龄与FH无关。自然青春期女孩的青春期生长为15.4±4.6 cm，诱导青春期女孩为8.6±4.3 cm（P < 0.0001）。我们得出结论，GH治疗可使大多数TS女孩的FH显著增加。在我们使用的GH治疗和青春期诱导条件下，GH治疗起始年龄与FH无关；此外，诱导或自然青春期的延迟或推迟并不影响FH。
