Wojniusz Slawomir, Callens Nina, Sütterlin Stefan, Andersson Stein, De Schepper Jean, Gies Inge, Vanbesien Jesse, De Waele Kathleen, Van Aken Sara, Craen Margarita, Vögele Claus, Cools Martine, Haraldsen Ira R
Division of Surgery and Clinical Neuroscience, Department of Medical Neurobiology, Oslo University HospitalOslo, Norway; Department of Physiotherapy, Oslo and Akershus University College of Applied SciencesOslo, Norway.
Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium.
Front Psychol. 2016 Jul 12;7:1053. doi: 10.3389/fpsyg.2016.01053. eCollection 2016.
Central precocious puberty (CPP) develops due to premature activation of the hypothalamic-pituitary-gonadal (HPG) axis, resulting in early pubertal changes and rapid bone maturation. CPP is associated with lower adult height and increased risk for development of psychological problems. Standard treatment of CPP is based on postponement of pubertal development by blockade of the HPG axis with gonadotropin releasing hormone analogs (GnRHa) leading to abolition of gonadal sex hormones synthesis. Whereas the hormonal and auxological effects of GnRHa are well-researched, there is a lack of knowledge whether GnRHa treatment influences psychological functioning of treated children, despite the fact that prevention of psychological problems is used as one of the main reasons for treatment initiation. In the present study we seek to address this issue by exploring differences in cognitive function, behavior, emotional reactivity, and psychosocial problems between GnRHa treated CPP girls and age-matched controls. Fifteen girls with idiopathic CPP; median age 10.4 years, treated with slow-release GnRHa (triptorelin acetate-Decapeptyl SR® 11.25) and 15 age-matched controls, were assessed with a comprehensive test battery consisting of paper and pencil tests, computerized tasks, behavioral paradigms, heart rate variability, and questionnaires filled in by the children's parents. Both groups showed very similar scores with regard to cognitive performance, behavioral and psychosocial problems. Compared to controls, treated girls displayed significantly higher emotional reactivity (p = 0.016; Cohen's d = 1.04) on one of the two emotional reactivity task conditions. Unexpectedly, the CPP group showed significantly lower resting heart rates than the controls (p = 0.004; Cohen's d = 1.03); lower heart rate was associated with longer treatment duration (r = -0.582, p = 0.037). The results suggest that GnRHa treated CPP girls do not differ in their cognitive or psychosocial functioning from age matched controls. However, they might process emotional stimuli differently. The unexpected finding of lower heart rate that was associated with longer duration of the treatment should be further explored by methods appropriate for assessment of cardiac health.
中枢性性早熟（CPP）是由于下丘脑-垂体-性腺（HPG）轴过早激活而发生的，导致青春期提前变化和骨骼快速成熟。CPP与成人身高较低以及出现心理问题的风险增加有关。CPP的标准治疗方法是通过使用促性腺激素释放激素类似物（GnRHa）阻断HPG轴来推迟青春期发育，从而导致性腺性激素合成停止。虽然GnRHa的激素和生长学效应已得到充分研究，但尽管预防心理问题被用作开始治疗的主要原因之一，但对于GnRHa治疗是否会影响接受治疗儿童的心理功能，仍缺乏相关了解。在本研究中，我们试图通过探索接受GnRHa治疗的CPP女孩与年龄匹配的对照组在认知功能、行为、情绪反应和心理社会问题方面的差异来解决这个问题。对15名患有特发性CPP的女孩（中位年龄10.4岁）进行了评估，她们接受了缓释GnRHa（醋酸曲普瑞林-Decapeptyl SR® 11.25）治疗，同时对15名年龄匹配的对照组进行了评估，评估采用了一系列综合测试，包括纸笔测试、计算机化任务、行为范式、心率变异性以及由儿童父母填写的问卷。两组在认知表现、行为和心理社会问题方面的得分非常相似。与对照组相比，在两种情绪反应任务条件中的一种条件下，接受治疗的女孩表现出显著更高的情绪反应（p = 0.016；Cohen's d = 1.04）。出乎意料的是，CPP组的静息心率显著低于对照组（p = 0.004；Cohen's d = 1.03）；心率较低与治疗持续时间较长有关（r = -0.582，p = 0.037）。结果表明，接受GnRHa治疗的CPP女孩在认知或心理社会功能方面与年龄匹配的对照组没有差异。然而，她们对情绪刺激的处理方式可能不同。治疗持续时间较长与心率较低这一意外发现，应通过适合评估心脏健康的方法进一步探索。
