Tatò L, Saggese G, Cavallo L, Antoniazzi F, Corrias A, Pasquino A M, Cisternino M
Pediatric Clinic, University of Verona, Italy.
Horm Res. 1995;44 Suppl 3:49-54. doi: 10.1159/000184674.
We studied 30 girls (age 6.36 +/- 1.21 years, range 4.6-8.8) affected by idiopathic precocious puberty with significant reduction of height velocity (below the 25th centile) at the end of 1 year of Gn-RHa (triptorelin intramuscular depot) treatment, to evaluate GH-IGF-I axis activity and the effects of combined Gn-RHa plus hGH therapy. After 12 months, 15 patients continued Gn-RHa and started hGH therapy for 12 months, while 15 continued treatment with Gn-RHa alone (control group). We evaluated height velocity, bone age, urinary GH, serum IGF-I and IGFBP-3 levels throughout the study; plasma GHBP levels were determined only in the first 12 months of Gn-RHa treatment. Height velocity decreased significantly during Gn-RHa treatment; it increased significantly and became higher than the control group after 12 months of Gn-RHa plus hGH treatment. During Gn-RHa therapy alone, bone age progressed less than chronological age, while in the 12 months of Gn-RHa plus hGH treatment there was a slight nonsignificant increase in bone age progression in comparison to controls. Serum IGF-I and IGFBP-3 levels decreased significantly at 12 months of Gn-RHa therapy and increased significantly after Gn-RHa plus hGH treatment. Urinary GH levels showed the same behavior. Plasma GH binding to peak II-BP, slightly lower than the prepubertal normal range before treatment, significantly increased after 12 months of Gn-RHa treatment. Therefore, in these girls, during Gn-RHa treatment alone, we have a reduction in GH-IGF-I axis activity. During Gn-RHa plus hGH therapy there was a significant increase in height velocity, in urinary GH levels, in serum IGF-I and IGFBP-3 levels. Bone age did not seem to advance faster than chronological age and this may imply a better prediction in adult height. In our opinion, only in a small percentage of patients affected by precocious puberty (with a very low predicted adult height or an important reduction of growth velocity during Gn-RHa treatment) may an association with hGH therapy be useful.
我们研究了30名患有特发性性早熟的女孩（年龄6.36±1.21岁，范围4.6 - 8.8岁），这些女孩在接受1年的促性腺激素释放激素类似物（曲普瑞林长效注射剂）治疗后身高增长速度显著降低（低于第25百分位数），以评估生长激素-胰岛素样生长因子-I（GH-IGF-I）轴的活性以及Gn-RHa联合生长激素（hGH）治疗的效果。12个月后，15名患者继续使用Gn-RHa并开始接受12个月的hGH治疗，而另外15名患者继续单独使用Gn-RHa治疗（对照组）。在整个研究过程中，我们评估了身高增长速度、骨龄、尿生长激素、血清胰岛素样生长因子-I（IGF-I）和胰岛素样生长因子结合蛋白-3（IGFBP-3）水平；仅在Gn-RHa治疗的前12个月测定了血浆生长激素结合蛋白（GHBP）水平。在Gn-RHa治疗期间身高增长速度显著下降；在Gn-RHa联合hGH治疗12个月后，身高增长速度显著增加且高于对照组。在单独使用Gn-RHa治疗期间，骨龄进展比实际年龄慢，而在Gn-RHa联合hGH治疗的12个月中，与对照组相比骨龄进展有轻微但不显著的增加。在Gn-RHa治疗12个月时，血清IGF-I和IGFBP-3水平显著下降，在Gn-RHa联合hGH治疗后显著升高。尿生长激素水平表现出相同的变化。与峰值II-BP结合的血浆生长激素，在治疗前略低于青春期前正常范围，在Gn-RHa治疗12个月后显著升高。因此，在这些女孩中，单独使用Gn-RHa治疗期间，GH-IGF-I轴活性降低。在Gn-RHa联合hGH治疗期间，身高增长速度、尿生长激素水平、血清IGF-I和IGFBP-3水平显著增加。骨龄似乎没有比实际年龄增长得更快，这可能意味着对成年身高有更好的预测。我们认为，仅在一小部分患有性早熟的患者中（预测成年身高非常低或在Gn-RHa治疗期间生长速度显著降低），联合hGH治疗可能有用。
