Boepple P A, Mansfield M J, Link K, Crawford J D, Crigler J F, Kushner D C, Blizzard R M, Crowley W F
Department of Medicine, Massachusetts General Hospital, Boston.
Am J Physiol. 1988 Oct;255(4 Pt 1):E559-66. doi: 10.1152/ajpendo.1988.255.4.E559.
Forty girls with central precocious puberty (CPP) were studied before and during 1-3 yr of luteinizing hormone-releasing factor (LHRH) agonist (LHRHa) administration to examine the impact of gonadal steroid secretion and its suppression on skeletal growth and maturation. Pubertal growth velocity (GV) was 10.1 +/- 0.7 (SE) cm/yr and, when normalized for chronological age (CA) and bone age (BA), demonstrated that the effects of sex steroids were most profound in patients with the youngest CA and BA. GV decreased significantly to 5.8 +/- 0.3 (n = 40), 4.6 +/- 0.3 (n = 30), and 3.2 +/- 0.6 cm/yr (n = 12) during 3 yr of gonadal suppression and correlated negatively with starting BA. Skeletal maturation was markedly accelerated by premature sex steroid secretion (BA/CA = 1.8 +/- 0.1), was slowed significantly with gonadal suppression (mean delta BA/delta CA less than 1), and also was negatively correlated with the starting BA. Cumulative increases in predicted adult height were observed regardless of starting BA and averaged +2.0 +/- 0.4, +5.2 +/- 0.5, and +6.7 +/- 1.2 cm after 1, 2, and 3 yr of gonadal suppression. The comparable changes in height predictions across all BAs despite highly variable GVs underscore the need for use of developmental (i.e., BA-based) rather than CA-based standards in the analysis of growth during gonadal steroid exposure and suppression in childhood.
对40名中枢性性早熟（CPP）女孩在使用促黄体生成激素释放因子（LHRH）激动剂（LHRHa）治疗前及治疗1 - 3年期间进行了研究，以检查性腺类固醇分泌及其抑制对骨骼生长和成熟的影响。青春期生长速度（GV）为10.1±0.7（标准误）cm/年，按实足年龄（CA）和骨龄（BA）进行标准化后发现，性类固醇对CA和BA最小的患者影响最为显著。在性腺抑制的3年期间，GV显著下降至5.8±0.3（n = 40）、4.6±0.3（n = 30）和3.2±0.6 cm/年（n = 12），且与起始骨龄呈负相关。过早的性类固醇分泌使骨骼成熟明显加速（BA/CA = 1.8±0.1），性腺抑制时显著减缓（平均BA变化/CA变化小于1），也与起始骨龄呈负相关。无论起始骨龄如何，在性腺抑制1、2和3年后均观察到预测成年身高的累积增加，平均分别增加2.0±0.4、5.2±0.5和6.7±1.2 cm。尽管GV高度可变，但所有骨龄的身高预测变化具有可比性，这突出表明在分析儿童性腺类固醇暴露和抑制期间的生长时，需要使用基于发育（即基于骨龄）而非基于实足年龄的标准。
