生长结局在 GnRH 激动剂治疗缓慢进展型中枢性性早熟中的表现。
Growth outcome during GnRH agonist treatments for slowly progressive central precocious puberty.
机构信息
Pediatric Endocrine Center, Department of Pediatrics, University of Pisa, Pisa, Italy.
出版信息
Neuroendocrinology. 2009;90(3):307-14. doi: 10.1159/000231994. Epub 2009 Jul 30.
BACKGROUND
Gonadotropin-releasing hormone agonists (GnRHa) represent the gold-standard treatment for central precocious puberty (CPP). In CPP children, GnRHa treatment slows bone age progression and preserves adult height (Ht) by suppressing sexual steroid secretion. In some patients, however, GnRHa induce an inappropriate growth deceleration impairing Ht outcome. Furthermore, slowly progressive CPP (spCPP) forms were reported which do not need GnRHa treatment.
METHODS
We evaluated the growth outcome of 26 spCPP girls treated with triptorelin (TR) and 21 with leuprorelin acetate (LA) for 36.5 +/- 0.7 months.
RESULTS
GnRHa treatment induced a progressive growth deceleration in both spCPP groups. No difference in bone maturation was detected (p > 0.05; TR vs. LA group), however compared to LA, TR treatment resulted in significantly higher Ht after 24 months (p < 0.05; LA vs. TR group). Although target height (TH) standard deviation score (SDS) and predicted adult height (PAH)-SDS at diagnosis were similar in both spCPP groups (p > 0.05; LA vs. TR group), final height (FH-SDS) was lower in LA-treated subjects (p < 0.05; LA vs. TR group). In both spCPP groups, FH-SDS was significantly lower than TH-SDS (p < 0.001) but not lower than PAH-SDS at diagnosis (p > 0.05). Ht-SDS correlated with 17beta-estradiol (E(2)) blood levels in both spCPP groups (p < 0.0001) throughout GnRHa treatment, and E(2) values were higher in the TR- than in the LA-treated patients during the 12 months after GnRHa administration (p < 0.05; LA vs. TR group). GnRHa-induced E(2) secretion and Ht-SDS at GnRHa withdrawal correlated positively with FH (p < 0.01 and p < 0.001, respectively).
CONCLUSIONS
The effectiveness of GnRHa treatment in improving FH in spCPP girls was doubtful.
背景
促性腺激素释放激素激动剂（GnRHa）是治疗中枢性性早熟（CPP）的金标准。在 CPP 患儿中，GnRHa 通过抑制性类固醇分泌来减缓骨龄进展并保留成人身高（Ht）。然而，在某些患者中，GnRHa 会导致不适当的生长减速，从而影响 Ht 结果。此外，还报道了不需要 GnRHa 治疗的缓慢进展性 CPP（spCPP）形式。
方法
我们评估了接受曲普瑞林（TR）治疗的 26 例 spCPP 女孩和接受亮丙瑞林醋酸酯（LA）治疗的 21 例 spCPP 女孩的生长结局，治疗时间为 36.5 +/- 0.7 个月。
结果
GnRHa 治疗在两个 spCPP 组中均诱导了渐进性生长减速。骨成熟度无差异（p > 0.05；TR 与 LA 组），然而与 LA 相比，TR 治疗在 24 个月后导致 Ht 显著增加（p < 0.05；LA 与 TR 组）。尽管两个 spCPP 组的靶身高（TH）标准差评分（SDS）和预测成人身高（PAH）-SDS 在诊断时相似（p > 0.05；LA 与 TR 组），但 LA 治疗组的最终身高（FH-SDS）较低（p < 0.05；LA 与 TR 组）。在两个 spCPP 组中，FH-SDS 均显著低于 TH-SDS（p < 0.001），但低于诊断时的 PAH-SDS（p > 0.05）。在整个 GnRHa 治疗期间，两个 spCPP 组的 Ht-SDS 均与 17β-雌二醇（E2）血水平相关（p < 0.0001），并且在 GnRHa 给药后 12 个月内，TR 治疗组的 E2 值高于 LA 治疗组（p < 0.05；LA 与 TR 组）。GnRHa 诱导的 E2 分泌和 GnRHa 停药时的 Ht-SDS 与 FH 呈正相关（p < 0.01 和 p < 0.001）。
结论
GnRHa 治疗在改善 spCPP 女孩 FH 方面的有效性值得怀疑。
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