游离α亚基是促性腺激素释放激素治疗中枢性性早熟后促性腺激素恢复的最敏感标志物。

Free alpha-subunit is the most sensitive marker of gonadotropin recovery after treatment of central precocious puberty with the histrelin implant.

机构信息

Department of Pediatrics, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem 91031, Israel.

出版信息

J Clin Endocrinol Metab. 2010 Jun;95(6):2841-4. doi: 10.1210/jc.2009-2078. Epub 2010 Mar 25.

DOI:10.1210/jc.2009-2078

PMID:20339028

Abstract

BACKGROUND

Gonadotropin free alpha-subunit (FAS) levels paradoxically increase during GnRH agonist (GnRHa) treatment of central precocious puberty (CPP). The histrelin implant suppresses gonadotropins and estradiol (E(2)) levels for 1 yr, but effects on FAS have not been described.

OBJECTIVES

We aimed to determine whether FAS levels remain elevated during treatment with the implant, to assess the dynamics of FAS after removal, and to ascertain the reliability of FAS for monitoring gonadotropin secretion.

METHODS

Ten girls with CPP were studied. In eight, monthly im GnRHa preparations were given until implant insertion. Two naive girls did not receive prior GnRHa. Duration of implant treatment ranged from 18-63 months with repeated implant removals and insertions of new implants. LH, FSH, E(2), and FAS were measured before implant insertion in the two naive patients and during treatment, and in all girls before and after implant removal.

RESULTS

FAS levels were 0.2 and 0.4 ng/ml (normal, <0.6 ng/ml) in the two naive girls and increased to 2.4 and 5.1 ng/ml within 2-5 d of insertion. FAS level (mean +/- SD) in all 10 girls during histrelin implant treatment was 1.19 +/- 0.49 ng/ml and rapidly decreased to 0.31 +/- 0.12 ng/ml within 1 wk of implant removal (P < 0.03). In contrast, significant increases in LH (P < 0.05) and FSH (P < 0.02) were observed at 3 wk and E(2) (P < 0.05) at 6 wk after implant removal.

CONCLUSIONS

Compared to LH, FSH, and E(2), FAS responds more rapidly to implant removal and represents the most sensitive indicator of gonadotropin recovery after histrelin implant treatment.

摘要

背景

促性腺激素释放激素激动剂（GnRHa）治疗中枢性性早熟（CPP）时，促性腺激素游离α亚单位（FAS）水平反常升高。曲普瑞林埋植剂可抑制促性腺激素和雌二醇（E2）达 1 年，但尚未描述其对 FAS 的影响。

目的

我们旨在确定 FAS 水平在植入物治疗期间是否仍升高，评估植入物去除后的 FAS 动态变化，并确定 FAS 监测促性腺激素分泌的可靠性。

方法

对 10 例 CPP 女孩进行研究。其中 8 例每月给予 GnRHa 制剂直至植入。2 例新患者未接受过 GnRHa 治疗。植入物治疗时间为 18-63 个月，反复取出和插入新植入物。在 2 例新患者植入前和治疗期间以及所有女孩植入前和取出后测量 LH、FSH、E2 和 FAS。

结果

在 2 例新患者中，FAS 水平分别为 0.2 和 0.4ng/ml（正常值<0.6ng/ml），在植入后 2-5d 内分别升高至 2.4 和 5.1ng/ml。在 10 例接受曲普瑞林埋植剂治疗的女孩中，FAS 水平（均值±SD）为 1.19±0.49ng/ml，在植入物取出后 1 周内迅速降至 0.31±0.12ng/ml（P<0.03）。相反，在植入物取出后 3 周时 LH（P<0.05）和 FSH（P<0.02）显著增加，6 周时 E2（P<0.05）增加。