Tanaka T, Satoh M, Hibi I
Division of Endocrinology & Metabolism, National Children's Hospital, Tokyo, Japan.
Endocr J. 1996 Oct;43 Suppl:S13-7. doi: 10.1507/endocrj.43.suppl_s13.
It has been reported that the final height in short children is strongly related to the height at the onset of pubertal development, and pubertal height gain in GH-treated children is not exceed the gain in normal children. Therefore, it is now the consensus that insufficient height at the onset of puberty leads to short final height. We have already demonstrated that the final height in GH-deficient children with spontaneous puberty with gonadal suppression therapy by medroxyprogesterone or cyproterone acetate was significantly taller than GHD with spontaneous puberty without gonadal suppression therapy. In this study, we treated short boys who started puberty at height shorter than 130 cm with combined GH and LHRH analog. Final height was predicted by the height SD score for bone age. Although pubertal growth spurt was not recognized in short children on combination treatment, bone age maturation over 11.5 years decelerated significantly to the rate of one year in three or four years. Even during this slow bone maturation period, growth velocity remained at 4 cm/year due to GH treatment. Therefore, height SDS for bone age was improved in combination with the elongation of treatment period by the slow bone maturation. Some investigators recommend not to delay induction if puberty much beyond the normal age to avoid psychological problems and ennuchoid proportion in these children. When we explained to our Japanese patients the chance of increasing the final height with gonadal suppression treatment and the risk of delaying the pubertal development, almost all children preferred taller final height to pubertal development and they did not experience much psychological trouble. The differences in social and cultural circumstances do, however, influence patients' preferences.
据报道，身材矮小儿童的最终身高与青春期发育开始时的身高密切相关，接受生长激素（GH）治疗的儿童青春期身高增长不超过正常儿童。因此，目前的共识是青春期开始时身高不足会导致最终身高矮小。我们已经证明，对于自然青春期的生长激素缺乏儿童，使用甲羟孕酮或醋酸环丙孕酮进行性腺抑制治疗后的最终身高显著高于未进行性腺抑制治疗的自然青春期生长激素缺乏儿童。在本研究中，我们对青春期开始时身高低于130厘米的矮小男孩联合使用生长激素和促性腺激素释放激素（LHRH）类似物进行治疗。通过骨龄的身高标准差分数预测最终身高。虽然联合治疗的矮小儿童未出现青春期生长突增，但骨龄超过11.5岁的成熟速度显著减慢，降至三四年每年一岁。即使在这个缓慢的骨成熟阶段，由于生长激素治疗，生长速度仍保持在每年4厘米。因此，随着骨成熟缓慢导致治疗期延长，骨龄的身高标准差分数得到改善。一些研究者建议不要过度延迟青春期启动，以免这些儿童出现心理问题和类无睾体型。当我们向日本患者解释性腺抑制治疗增加最终身高的可能性以及延迟青春期发育的风险时，几乎所有儿童都更倾向于更高的最终身高而非青春期发育，并且他们并未经历太多心理困扰。然而，社会和文化环境的差异确实会影响患者的偏好。
