HPGA抑制程度对ICPP女童成年预测身高的影响

发布时间：2019-01-02 15:31

【摘要】：目的探索促性腺激素释放激素类似物(gonadotropin releasing hormone analogue,GnRHa)治疗过程中下丘脑-垂体-性腺轴(hypothalamie pituitary gonadal axis,HPGA)的抑制程度与特发性中枢性性早熟(idiopathic central precocious puberty,ICPP)女童成年预测身高(predicted adult height,PAH)之间的关系,以指导临床GnRHa治疗剂量的个体化调节,寻找最佳的HPGA抑制范围,尽可能地改善患儿PAH,避免联合使用重组人生长激素(recombinant human growth hormone,rhGH)。方法回顾性分析2009年5月至2016年4月我院专病门诊诊治的158例接受GnRHa治疗的ICPP女童临床资料,包括初治年龄、身高、体重、骨龄、子宫卵巢容积、LH、FSH基础水平及峰值、E2水平、有无月经来潮、父母身高等;其中GnRHa治疗半年以上的达158人,12个月158人,18个月123人,24个月93人,30个月63人,36个月39人,42个月17人,48个月6人。并记录GnRHa治疗后各时间点患儿的身高、体重、实际年龄、骨龄、子宫卵巢容积及LH峰值、FSH峰值、E2水平等指标,计算各时间点PAH、ABA(BA-CA),分析APAH(PAH-靶身高)改变的情况,及其与HPGA抑制的关系,并采用阈值效应分析寻找最佳APAH时的HPGA抑制范围。结果GnRHa治疗后患儿PAH较治疗初期有明显改善。APAH与ABA呈负相关,与子宫卵巢容积、LH、FSH及E2均无直接相关性。Pearson相关性检验显示:ABA与FSH的水平无直接相关性,治疗12个月时,ABA与子宫容积成正相关(r=0.17,P=0.035,n=158);治疗24个月时ABA与卵巢容积呈正相关(r=0.34,P=0.001,n=93),治疗42个月时ABA与LH水平呈正相关(r=0.57,P=0.016,n=17)。阈值效应分析结果显示:将子宫容积控制在1.2-1.8ml之间、卵巢容积控制在1.1ml以下、LH控制在0.4-1.8 IU/L之间、FSH控制在2.5 IU/L以下对延缓BA的增长及改善PAH最有利。结论GnRHa治疗能有效改善性早熟女童的成年预测身高。选择合适的GnRHa治疗剂量,将子宫卵巢容积、LH、FSH控制在一定范围内,有利于延缓骨龄进展及改善成年预测身高,可避免联合使用重组人生长激素。
[Abstract]:Objective to investigate the inhibition degree of hypothalamus-pituitary-gonadal axis (hypothalamie pituitary gonadal axis,HPGA) and idiopathic central precocious (idiopathic central precocious puberty, during the treatment of gonadotropin releasing hormone analogue (gonadotropin releasing hormone analogue,GnRHa). (ICPP) the relationship between female adult predictive height (predicted adult height,PAH) to guide the individualized regulation of clinical GnRHa dosage, to find the best range of HPGA inhibition, and to improve PAH, in children as far as possible. Avoid combined use of recombinant human growth hormone (recombinant human growth hormone,rhGH). Methods the clinical data of 158 ICPP girls treated with GnRHa from May 2009 to April 2016 were analyzed retrospectively, including age of first treatment, height, weight, bone age, volume of uterus and ovary, basic level and peak value of LH,FSH. E2 level, menstruation or not, parents height, etc. Of them, 158 were treated with GnRHa for more than half a year, 158 in 12 months, 123 in 18 months, 93 in 24 months, 63 in 30 months, 39 in 36 months, 17 in 42 months and 6 in 48 months. The height, weight, actual age, bone age, uterine and ovarian volume, peak value of LH, FSH and E2 were recorded at each time point after GnRHa treatment. PAH,ABA (BA-CA) was calculated at each time point. The changes of APAH (PAH- target height) and its relationship with HPGA inhibition were analyzed. The threshold effect was used to find the best range of HPGA inhibition for APAH. Results there was a significant improvement in PAH after GnRHa treatment. There was a negative correlation between APAH and ABA, but no direct correlation with the volume of uterus and ovary, LH,FSH and E2. Pearson correlation test showed that there was no direct correlation between ABA and FSH. After 12 months of treatment, ABA was positively correlated with uterine volume (r = 0.17, P = 0.035, n = 158). There was a positive correlation between ABA and ovarian volume at 24 months after treatment (r = 0.34), and a positive correlation between ABA and LH at 42 months (r = 0.57). The results of threshold effect analysis showed that the uterine volume was controlled between 1.2-1.8ml, ovarian volume was controlled below 1.1ml, and LH was controlled between 0.4 and 1.8 IU/L. FSH control below 2. 5 IU/L was most beneficial for delaying the growth of BA and improving PAH. Conclusion GnRHa treatment can effectively improve the adult predictive height of precocious girls. Choosing the appropriate dosage of GnRHa, controlling the volume of uterus and ovary and controlling LH,FSH within a certain range can delay the progression of bone age and improve adult prediction of height, and avoid the combined use of recombinant human growth hormone.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.8

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