Endocr Pract. 2019 Jul;25(7):717-728. doi: 10.4158/EP-2019-0008. Epub 2019 Apr 23.
The optimal treatment for girls with central precocious puberty (CPP) is unknown. We conducted a network meta-analysis to evaluate the efficacy and safety of existing treatments to provide credible clinical guidelines. We compared gonadotropin-releasing hormone analogue (GnRHa) therapy, GnRHa plus growth hormone (GH) combination therapy, and no-treatment therapy for girls with CPP by performing an electronic search for studies in PubMed, Embase, Chinese National Knowledge Infrastructure databases, and Wanfang Data from their inception until September 30, 2018. Six outcomes, including bone maturation ratio, final height, final height compared with target height, growth velocity, height gain, and gain in predicted adult height (ΔPAH), were expressed as the mean difference with 95% confidence interval. The surface under the cumulative ranking curve (SUCRA) value illustrated the rank probability of each treatment under different outcomes. Twenty-two studies with 1,268 patients were included. GnRHa plus GH had the best performance on final height, final height compared with target height, growth velocity, height gain, and ΔPAH, with the highest SUCRA values of 0.919, 0.975, 0.909, 0.999, and 0.957, respectively. For bone maturation ratio, GnRHa ranked the highest, with a SUCRA value of 0.663. No severe adverse effects were reported. For girls with CPP, GnRHa plus GH had the highest probability of being the optimal therapy for improving final height, and no severe adverse effects were reported. = body mass index; = confidence interval; = central precocious puberty; = growth hormone; = gonadotropin-releasing hormone analogue; = hypothalamic-pituitary-gonadal; = luteinizing hormone; = network meta-analysis; = predicted adult height; = polycystic ovary syndrome; = randomized controlled trial; = surface under the cumulative ranking curve.
对于中枢性性早熟（CPP）女孩的最佳治疗方法尚不清楚。我们进行了一项网络荟萃分析，以评估现有治疗方法的疗效和安全性，为临床提供可靠的指导。我们通过检索PubMed、Embase、中国知网和万方数据库自成立以来至 2018 年 9 月 30 日的研究，比较了促性腺激素释放激素类似物（GnRHa）治疗、GnRHa 联合生长激素（GH）联合治疗和 CPP 女孩的无治疗疗法。六项结局指标包括骨龄成熟比、最终身高、最终身高与靶身高的比较、生长速度、身高增长和预测成人身高（ΔPAH）的增长，以均数差和 95%置信区间表示。累积排序曲线下面积（SUCRA）值说明了在不同结局下每种治疗方法的排名概率。纳入 22 项研究共 1268 例患者。GnRHa 联合 GH 在最终身高、最终身高与靶身高的比较、生长速度、身高增长和 ΔPAH 方面表现最好，SUCRA 值分别为 0.919、0.975、0.909、0.999 和 0.957。对于骨龄成熟比，GnRHa 排名最高，SUCRA 值为 0.663。未报告严重不良事件。对于 CPP 女孩，GnRHa 联合 GH 最有可能成为改善最终身高的最佳治疗方法，且未报告严重不良事件。
