Lin Yi-Chun, Lin Chih-Ying, Chee Siew-Yin, Yen Hung-Rong, Tsai Fuu-Jen, Chen Chiu-Ying, Wang Chung-Hsing
Department of Chinese Medicine, China Medical University Hospital, Taichung City, Taiwan.
Department of Public Health, Doctoral Program, China Medical University, Taichung, Taiwan.
PLoS One. 2017 Oct 3;12(10):e0185080. doi: 10.1371/journal.pone.0185080. eCollection 2017.
The adult height of children with early onset puberty is limited by the premature maturation of hypothalamic-pituitary-gonadal axis. To evaluate the effects of gonadotropin-releasing hormone analog (GnRHa) treatment on the final height (FH) and bone maturation rate (BMR) in girls with early puberty (EP) or idiopathic central precocious puberty (ICPP), we examined data from girls who were diagnosed with EP or ICPP and underwent GnRHa (Leuplin Depot: 3.75 mg/month) at China Medical University Hospital, in Taiwan, between 2006 and 2015. Patients were observed until the achievement of FH and divided into an "EP group" (T-ep) and "ICPP group" (T-icpp) according to the age of onset of puberty. Eighty-seven patients were enrolled (T-ep, N = 44, puberty onset at 8-10 years; T-icpp, N = 43, puberty onset before 8 years). The demographic data of girls with EP or IPP was characterized. BMR, change in predicted final height (PFH) after GnRHa treatment, target height (TH) and FH were measured. After GnRHa treatment, the study groups (T-ep: 160.24±6.18 cm, T-icpp: 158.99±5.92 cm) both had higher PFH than at initiation (T-ep: 159.83±7.19 cm, T-icpp: 158.58±5.93 cm). There was deceleration of BMR in both groups (T-ep: 0.57±0.39; T-icpp: 0.97±0.97) and a significant difference between the groups (p = 0.027). The gap in FH standard deviation scores (SDS) and TH SDS had a significant difference in T-ep (p = 0.045) but not in T-icpp. Moreover, there was no difference in the gap of PFH SDS between the 1st and final treatment in both groups. We concluded that GnRHa decelerated BMR in girls with earlier puberty. Further prospective clinical studies are warranted.
性早熟儿童的成人身高受到下丘脑 - 垂体 - 性腺轴过早成熟的限制。为了评估促性腺激素释放激素类似物（GnRHa）治疗对青春期早熟（EP）或特发性中枢性性早熟（ICPP）女孩的最终身高（FH）和骨成熟率（BMR）的影响，我们研究了2006年至2015年期间在台湾中国医科大学医院被诊断为EP或ICPP并接受GnRHa（亮丙瑞林长效注射剂：3.75毫克/月）治疗的女孩的数据。观察患者直至达到最终身高，并根据青春期开始年龄分为“EP组”（T - ep）和“ICPP组”（T - icpp）。共纳入87例患者（T - ep组，N = 44，青春期开始于8至10岁；T - icpp组，N = 43，青春期开始于8岁之前）。对EP或IPP女孩的人口统计学数据进行了描述。测量了BMR、GnRHa治疗后预测最终身高（PFH）的变化、靶身高（TH）和FH。GnRHa治疗后，研究组（T - ep组：160.24±6.18厘米，T - icpp组：158.99±5.92厘米）的PFH均高于开始治疗时（T - ep组：159.83±7.19厘米，T - icpp组：158.58±5.93厘米）。两组的BMR均有减缓（T - ep组：0.57±0.39；T - icpp组：0.97±0.97），且两组之间存在显著差异（p = 0.027）。FH标准差分数（SDS）和TH SDS的差距在T - ep组有显著差异（p = 0.045），而在T - icpp组无显著差异。此外，两组在首次治疗和最终治疗时PFH SDS的差距无差异。我们得出结论，GnRHa可减缓青春期较早女孩的BMR。有必要进行进一步的前瞻性临床研究。
