Pasquino A M, Municchi G, Pucarelli I, Segni M, Mancini M A, Troiani S
Pediatric Department, University La Sapienza, Rome, Italy.
J Clin Endocrinol Metab. 1996 Mar;81(3):948-51. doi: 10.1210/jcem.81.3.8772556.
GnRH analogs (GnRHa) arrest pubertal development and slow growth velocity (GV) and bone maturation, thus improving adult height in central precocious puberty (CPP). In some patients, however, GV decreases to such an extent that it compromises the improvement in predicted adult height (PAH). Fourteen children (10 girls and 4 boys) with idiopathic CPP whose GV during GnRHa treatment decreased below the 25th percentile for chronological age with no improvement in PAH received GH at a dose of 0.3 mg/kg week, sc, 6 days/week for 2-3 yr. Fourteen children (10 girls and 4 boys) with idiopathic CPP, matched for bone age (BA), chronological age, and duration of GnRHa treatment, who showed the same growth deceleration but refused GH treatment, served as the control group. In girls, GV as so score for BA improved from -3.4 +/- 0.5 to -2.5 +/- 0.5 after 3 yr of combined treatment; PAH significantly improved from 152.7 +/- 1.7 cm (before GnRHa) and 153.5 +/- 1.7 cm (before GnRHa and GH) to 167.1 +/- 3.0 cm after 3 yr of combined treatment (P < 0.01 vs. pretreatment with GnRHa plus GH). In boys, GV as SD score for BA remained unchanged from -2.0 +/- 1.0 to -2.2 +/- 1.2 after 2 yr of combined treatment; PAH increased from 166.6 +/- 4.8 cm (before GnRHa) and 166.2 +/- 4.9 (before GnRHa plus GH) to 171.1 +/- 6.1 cm after 2 yr (P = NS). In the control group, in girls after 6 yr of GnRHa treatment, height in SD score for BA improved from -1.0 +/- 0.3 to -0.1 +/- 0.4 (P = NS), and PAH significantly improved from 155.5 +/- 2.0 to 161.5 +/- 2.1 cm (P < 0.05); in boys after 4 yr of GnRHa treatment, height in SD score for BA improved from -1.1 +/- 0.3 to -0.3 +/- 0.4 (P = NS), and PAH changed from 172.6 +/- 3.6 to 170.3 +/- 3.6 cm (P = NS). Eight of 10 girls receiving GH plus GnRHa treatment had an actual height higher than PAH and their target height. The results of our long term study indicate that in children with CPP who show a marked decrease in GV during GnRHa treatment, GH administration remarkably improves growth velocity and predicted adult height, especially in girls.
促性腺激素释放激素类似物（GnRHa）可抑制青春期发育，减缓生长速度（GV）和骨骼成熟，从而提高中枢性性早熟（CPP）患者的成年身高。然而，在一些患者中，生长速度下降到一定程度，以至于影响了预测成年身高（PAH）的改善。14例特发性CPP患儿（10例女孩，4例男孩）在GnRHa治疗期间生长速度降至按实际年龄计算的第25百分位数以下，且预测成年身高无改善，接受皮下注射生长激素（GH），剂量为0.3mg/kg每周，每周6天，共治疗2 - 3年。另外14例特发性CPP患儿（10例女孩，4例男孩），年龄、骨龄（BA）和GnRHa治疗时间相匹配，生长速度同样减慢，但拒绝接受GH治疗，作为对照组。在女孩中，联合治疗3年后，以骨龄计算的生长速度标准差评分从 - 3.4±0.5提高到 - 2.5±0.5；预测成年身高从GnRHa治疗前的152.7±1.7cm和GnRHa加GH治疗前的153.5±1.7cm显著提高到联合治疗3年后的167.1±3.0cm（与GnRHa加GH治疗前相比，P < 0.01）。在男孩中，联合治疗2年后，以骨龄计算的生长速度标准差评分从 - 2.0±1.0保持在 - 2.2±1.2；预测成年身高从GnRHa治疗前的166.6±4.8cm和GnRHa加GH治疗前的166.2±4.9cm提高到2年后的171.1±6.1cm（P = 无统计学意义）。在对照组中，女孩接受GnRHa治疗6年后，以骨龄计算的身高标准差评分从 - 1.0±0.3提高到 - 0.1±0.4（P = 无统计学意义），预测成年身高从155.5±2.0显著提高到161.5±2.1cm（P < 0.05）；男孩接受GnRHa治疗4年后，以骨龄计算的身高标准差评分从 - 1.1±0.3提高到 - 0.3±0.4（P = 无统计学意义），预测成年身高从172.6±3.6变为170.3±3.6cm（P = 无统计学意义）。接受GH加GnRHa治疗的10例女孩中有8例实际身高高于预测成年身高和其靶身高。我们的长期研究结果表明，对于在GnRHa治疗期间生长速度显著下降的CPP患儿，给予GH可显著提高生长速度和预测成年身高，尤其是女孩。
