促性腺激素释放激素类似物联合司坦唑醇对特发性中枢性性早熟且线性生长明显减慢女童最终身高的影响

[Effect of gonadotropin-releasing hormone analog combined with stanazolol on final height in girls with idiopathic central precocious puberty and apparent decrease of linear growth].

作者信息

Li Yan-hong, Zhu Shun-ye, Ma Hua-mei, Su Zhe, Chen Hong-shan, Chen Qiu-li, Gu Yu-fen, Du Min-lian

机构信息

Department of Pediatrics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China.

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出版信息

Zhonghua Er Ke Za Zhi. 2013 Nov;51(11):807-12.

PMID:24484553

Abstract

OBJECTIVE

To evaluate the effect of combined use of stanazolol (ST) on the final adult height (FAH) in girls with idiopathic central precocious puberty (ICPP) and apparently decreased linear growth during gonadotropin-releasing hormone analog (GnRHa) therapy.

METHOD

Sixty-three girls with ICPP and decreased velocity of growth of height (HV<4 cm/yr) during GnRHa therapy were divided into 3 groups based on the following types of interventions:group 1 (n = 20), GnRHa+ST [25-30 µg/(kg·d) every 3-month followed by 3-month discontinuation], group 2 (n = 21), GnRHa+recombinant human growth hormone [rhGH, 1-1.1 U/(kg·w)], group 3 (n = 22), GnRHa alone.HV, the advancement of bone age (BA) for chronological age (CA) (ΔBA/ΔCA) and FAH were compared among groups.

RESULT

(1)Total duration of ST combination therapy was (12.22 ± 3.62) months, while total duration of combination of rhGH was (13.22 ± 6.80) months. (2)HV increased significantly in both group 1 [ (2.79 ± 0.60) cm/yr vs. (6.27 ± 1.98) cm/yr, P < 0.01] and in group 2 [(2.80 ± 0.50) cm/yr vs. (6.25 ± 1.98) cm/yr, P < 0.01] during combined therapy, but maintained at low levels in group 3 [(3.95 ± 1.10) cm/yr vs. (3.34 ± 0.95) cm/yr, P > 0.05].No significant differences of ΔBA/ΔCA were found among the three groups [0.25(0.11∼0.28), 0.22(0.15∼0.31),0.19(0.10∼0.32), P > 0.05]. (3)FAH was significantly higher than predicted adult height (PAH) before combined therapy, as well as higher than target height (THt) in both group 1 [(156.25 ± 2.90) cm vs. (150.78 ± 3.70) cm, P < 0.01, (156.25 ± 2.90) cm vs. (153.94 ± 2.62) cm, P < 0.01], and in group2 [ (157.33 ± 4.69) cm vs. (152.61 ± 3.92) cm, P < 0.01, (157.33 ± 4.69) cm vs. (154.39 ± 4.72) cm, P = 0.01].In group 3, FAH was similar to PAH [(153.88 ± 2.6) cm vs. (152.54 ± 5.86) cm, P > 0.05], and was less than THt [(153.88 ± 2.6) cm vs. (155.60 ± 4.52) cm, P = 0.02]. (4)In girls treated with ST, no hirsutism, clitorism or hoarse voice was recorded.No polycystic ovary syndrome was found by B-mode ultrasound.

CONCLUSION

Intermittent combined use of low dose ST therapy can increase HV and thus improve FAH in girls with ICPP and apparently decreased linear growth during GnRHa therapy.

摘要

目的

评估司坦唑醇（ST）联合使用对特发性中枢性性早熟（ICPP）且在促性腺激素释放激素类似物（GnRHa）治疗期间线性生长明显减缓的女孩最终成年身高（FAH）的影响。

方法

63例ICPP且在GnRHa治疗期间身高增长速度减慢（身高增长速度<4厘米/年）的女孩，根据以下干预类型分为3组：第1组（n = 20），GnRHa + ST[每3个月25 - 30μg/（kg·d），随后停药3个月]，第2组（n = 21），GnRHa + 重组人生长激素[rhGH，1 - 1.1U/（kg·周）]，第3组（n = 22），仅GnRHa。比较各组的身高增长速度（HV）、骨龄（BA）相对于实足年龄（CA）的进展（ΔBA/ΔCA）和FAH。

结果

（1）ST联合治疗的总疗程为（12.22±3.62）个月，而rhGH联合治疗的总疗程为（13.22±6.80）个月。（2）联合治疗期间，第1组[（2.79±0.60）厘米/年对（6.27±1.98）厘米/年，P<0.01]和第2组[（2.80±0.50）厘米/年对（6.25±1.98）厘米/年，P<0.01]的HV均显著增加，但第3组维持在低水平[（3.95±1.10）厘米/年对（3.34±0.95）厘米/年，P>0.05]。三组间ΔBA/ΔCA无显著差异[0.25（0.11～0.28），0.22（0.15～0.31），0.19（0.10～0.32），P>0.05]。（3）联合治疗前，FAH显著高于预测成年身高（PAH），且在第1组[（156.25±2.90）厘米对（150.78±3.70）厘米，P<0.01，（156.25±2.90）厘米对（153.94±2.62）厘米，P<0.01]和第2组[（157.33±4.69）厘米对（152.61±3.92）厘米，P<0.01，（157.33±4.69）厘米对（154.39±4.72）厘米，P = 0.01]均高于靶身高（THt）。在第3组中，FAH与PAH相似[（153.88±2.6）厘米对（152.54±5.86）厘米，P>0.05]，且低于THt[（153.88±2.6）厘米对（155.60±4.52）厘米，P = 0.02]。（4）接受ST治疗的女孩未记录到多毛症、阴蒂肥大或声音嘶哑。B超未发现多囊卵巢综合征。