曲普瑞林联合重组人生长激素治疗女童中枢性性早熟的临床疗效观察

宋建; 崔北勇; 诸宏伟

doi:10.16766/j.cnki.issn.1674-4152.003166

曲普瑞林联合重组人生长激素治疗女童中枢性性早熟的临床疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.003166

1.
蚌埠市第一人民医院儿科，安徽蚌埠 233000
2.
蚌埠医学院第一附属医院儿科，安徽蚌埠 233004
3.
蚌埠医学院第一附属医院儿科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究重点项目 KJ2021A0797

详细信息

通讯作者:
诸宏伟，E-mail: zhuhongwei51136@126.com

中图分类号: R729
计量
- 文章访问数: 118
- HTML全文浏览量: 43
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2022-06-06
- 网络出版日期: 2023-10-19

Therapeutic effect of triptorelin combined with recombinant human growth hormone on central precocious puberty in girls

1.
Department of Pediatrics, Bengbu First People' s Hospital, Bengbu, Anhui 233000, China

摘要

摘要: 目的研究曲普瑞林联合重组人生长激素治疗中枢性性早熟女童的临床效果。方法选取2018年8月-2020年8月蚌埠市第一人民医院收治的中枢性性早熟女童60例, 依据治疗方式不同, 分为单独曲普瑞林治疗组(对照组)30例和曲普瑞林联合重组人生长激素治疗组(观察组)30例, 观察2组女童治疗后性激素水平变化、胰岛素样生长因子1(IGF-1)和胰岛素样生长因子结合蛋白3(IGFBP-3)变化、临床疗效、不良反应发生率。结果对照组与观察组治疗后的促卵泡生成素[(2.52±0.63) U/L vs.(2.42±0.56) U/L]、黄体生成素[(1.56±0.52) U/L vs.(1.62±0.60) U/L]、雌二醇[(10.84±2.50) ng/L vs.(12.10±3.20) ng/L]比较, 差异无统计学意义(均P>0.05)。治疗后, 与对照组比较, 观察组IGF-1[(345.62±39.65)μg/L)vs.(282.02±25.40)μg/L)]、IGFBP-3[(5.54±2.64) mg/L vs.(4.22±1.46) mg/L]明显升高(均P < 0.05)。治疗后, 与对照组比较, 观察组预测成年身高[(161.4±5.2) cm vs.(154.2±3.8) cm]、生长速度[(9.8±2.8) cm/年vs.(6.2±2.0) cm/年]显著增高(均P < 0.05), 但2组患儿骨龄比较差异无统计学意义[(10.3±0.5)岁vs.(10.1±0.7)岁, P>0.05]。2组患儿的不良反应轻微, 发生率不高, 通过治疗可以控制。结论曲普瑞林联合重组人生长激素治疗女童中枢性性早熟疗效明显, 对生长发育指标具有积极的意义, 值得临床应用。
- 曲普瑞林 /
- 重组人生长激素 /
- 女童中枢性性早熟 /
- 临床疗效
Abstract: Objective To study the clinical effect of triptorelin combined with recombinant human growth hormone in the treatment of girls with central precocious puberty (CPP). Methods Sixty girls with CPP admitted to Department of Pediatrics of Bengbu First People's Hospital from August 2018 to August 2020 were divided into control group (n=30) and study group (n=30).The control group was given triptorelin therapy, and the study group was given triptorelin combined with recombinant human growth hormone therapy.The changes of sex hormone level, insulin-like growth factor-1(IGF-1), insulin-like growth factor binding protein-3(IGFBP-3), clinical efficacy and incidence of adverse reactions were observed. Results There were no significant differences in the levels of FSH[(2.52±0.63) U/L vs.(2.42±0.56) U/L], LH[(1.56±0.52) U/L vs.(1.62±0.60) U/L]and E2[(10.84±2.50) ng/L vs.(12.10±3.20) ng/L]between the control group and the study group after treatment (P>0.05).IGF-1[(345.62±39.65)μg/L vs.(282.02±25.40)μg/L]and IGFBP-3[(5.54±2.64) mg/L vs.(4.22±1.46) mg/L]levels in the study group were significantly higher than those in the control group after treatment, and the differences were statistically significant (all P < 0.05).The levels of predicted adult height[(161.4±5.2) cm vs.(154.2±3.8) cm]and growth velocity[(9.8±2.8) cm per year vs.(6.2±2.0) cm per year]in the study group were significantly higher than those in the control group, and the differences were statistically significant (all P < 0.05).But there was no significant difference in bone age[(10.3±0.5) year of age vs.(10.1±0.7) year of age]between the two groups after treatment (P>0.05).The adverse reactions of the two groups of children were mild, the incidence was not high and could be controlled by treatment. Conclusion Triptorelin combined with recombinant human growth hormone has a significant effect in the treatment of girls with CPP.It has positive significance for growth and development indicators, and is worthy of clinical promotion and application.
- Triptorelin /
- Recombinant human growth hormone /
- Girls with central precocious puberty /
- Clinical efficacy

HTML全文

表 1 2组中枢性性早熟女童血清性激素水平比较(x±s)

Table 1. Comparison of serum sex hormone levels in girls with central precocious puberty in two groups(x±s)

组别	例数	FSH(U/L)		t值	P值	LH(U/L)		t值	P值	E2(ng/L)		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	3.82±0.54	2.52±0.63	22.760	< 0.001	3.48±0.46	1.56±0.52	19.021	< 0.001	20.50±4.62	10.84±2.50	11.285	< 0.001
观察组	30	3.64±0.52	2.42±0.56	21.433	< 0.001	3.28±0.48	1.62±0.60	28.147	< 0.001	22.42±5.22	12.10±3.20	19.649	< 0.001
t值		1.315	0.650			1.648	0.414			1.509	1.699
P值		0.194	0.518			0.105	0.680			0.137	0.095

下载: 导出CSV

表 2 2组中枢性性早熟女童IGF-1、IGFBP-3比较(x±s)

Table 2. Comparison of IGF-1, IGFBP-3 in girls with central precocious puberty in two groups(x±s)

组别	例数	IGF-1(μg/L)		t值	P值	IGFBP-3(mg/L)		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	276.42±22.24	282.02±25.40	1.534	0.136	4.25±2.12	4.22±1.46	0.274	0.786
观察组	30	283.86±16.28	345.62±39.65	10.244	< 0.001	4.12±2.34	5.54±2.64	32.407	< 0.001
t值		1.479	7.398			0.226	2.397
P值		0.145	< 0.001			0.822	0.020

下载: 导出CSV

表 3 2组中枢性性早熟女童预测成年身高、生长速度、骨龄比较(x±s)

Table 3. Comparison of PAH, GV and BA in girls with central precocious puberty in two groups(x±s)

组别	例数	PAH(cm)		GV(cm/年)		BA(岁)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	30	149.4±5.8	154.2±3.8	5.5±0.6	6.2±2.0	9.6±0.8	10.1±0.7
观察组	30	151.2±5.6	161.4±5.2	5.3±0.5	9.8±2.8	9.5±0.6	10.3±0.5
t值		1.223	6.123	1.403	5.732	0.548	1.273
P值		2.226	< 0.001	0.166	< 0.001	0.586	0.208

下载: 导出CSV

表 4 2组中枢性性早熟女童不良反应发生情况比较[例(%)]

Table 4. Comparison of adverse reactions in girls with central precocious puberty in two groups[cases (%)]

组别	例数	空腹血糖增高	甲状腺功能减退	头痛	恶性肿瘤
对照组	30	0	0	3(10.0)	0
观察组	30	4(13.3)	5(16.7)	2(6.7)	0
χ²值		2.411	3.491	< 0.001
P值		0.121	0.062	0.999

下载: 导出CSV

参考文献(21)

[1]	刘虹, 白涛敏, 韩田田, 等. 曲普瑞林联合小剂量生长激素物治疗女童CPP疗效及对骨龄的影响[J]. 现代生物医学进展, 2021, 21(11): 2113-2116. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202111025.htm LIU H. BAI T M. HAN T T. et al. Efficacy of triptorelin combined with Low-dose growth hormone on central precocious puberty in girls[J]. Progress in Modern Biomedicine, 2021, 21(11): 2113-2116. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202111025.htm
[2]	DAYAL D, AGGARWAL A, SEETHARAMAN K, et al. Central precocious puberty complicating congenital adrenal hyperplasia: north indian experience[J]. Indian J Endocrinol Metab, 2018, 22(6): 858-859. doi: 10.4103/ijem.IJEM_254_18
[3]	ZHAO Y, LONG W J, DU C Q, et al. Prevalence of vitamin D deficiency in girls with idiopathic central precocious puberty[J]. Front Med, 2018, 12(2): 174-181. doi: 10.1007/s11684-017-0544-5
[4]	BERTELLONI S, MASSART F, MICCOLI M, et al. Adult height after spontaneous pubertal growth or GnRH analog treatment in girls with early puberty: a meta-analysis[J]. Eur J Pediatr, 2017, 176(6): 697-704. doi: 10.1007/s00431-017-2898-8
[5]	陈雪. 重组人生长激素治疗儿童生长激素缺乏症和特发性矮小症的安全性分析[J]. 系统医学, 2019, 4(9): 120-121, 127. https://www.cnki.com.cn/Article/CJFDTOTAL-XTYX201909049.htm CHEN X. Safety analysis of recombinant human growth hormone in the treatment of growth hormone deficiency and idiopathic dwarfism in children[J]. Systems Medicine, 2019, 4(9): 120-121, 127. https://www.cnki.com.cn/Article/CJFDTOTAL-XTYX201909049.htm
[6]	梁雁, 杜敏联, 罗小平. 中枢性性早熟诊断与治疗共识(2015)[J]. 中华儿科杂志, 2015, 53(6): 412-418. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202306008.htm LIANG Y, DU M L, LUO X P. Consensus on diagnosis and treatment of central precocious puberty(2015)[J]. Chin J Pediatr, 2015, 53(6): 412-418. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202306008.htm
[7]	王蕾. 特发性中枢性性早熟女童GnRHa治疗前后心理行为的变化[J]. 中外医学研究, 2018, 16(15): 99-100. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY201815043.htm WANG L. Changes of mental behaviors in patients with idiopathic central precocious puberty before and after treatment of GnRHa[J]. Chinese and Foreign Medical Research, 2018, 16(15): 99-100. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY201815043.htm
[8]	罗小娟, 曹科. 性早熟女童EEDs暴露及表观遗传学发病机制研究进展[J]. 海南医学, 2017, 28(1): 122-123. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN201701038.htm LUO X J. CAO K. Advances in the study of EEDS exposure and the pathogenesis of Epigenetics in girls with precocious puberty[J]. Hainan Med J, 2017, 28(1): 122-123. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN201701038.htm
[9]	徐璟, 陈亚楠, 楼正渊, 等. 儿童性早熟与生活方式及家族因素相关性分析[J]. 中国学校卫生, 2017, 38(6): 882-884. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201706029.htm XU J, CHEN Y N, LOU Z Y, et al. Correlation analysis of lifestyle. family factors associated and precocious puberty[J]. Chinese Journal of School Health, 2017, 38(6): 882-884. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201706029.htm
[10]	陈赛兰, 张丹丹, 高琴, 等. 醋酸曲普瑞林在治疗女性中枢性性早熟中的临床疗效与安全性探讨[J]. 中国性科学, 2017, 26(5): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-XKXZ201705015.htm CHEN S L, ZHANG D D, GAO Q, et al. The curative effect and security of triptorelin acetate in the treatment of female patients with central precocious puberty[J]. Chinese Journal of Human Sexuality, 2017, 26(5): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-XKXZ201705015.htm
[11]	林杨, 江世锁, 潘家华, 等. 重组人生长激素治疗不同骨龄生长激素缺乏症患儿的疗效观察[J]. 中华全科医学, 2019, 17(7): 1146-1149. doi: 10.16766/j.cnki.issn.1674-4152.000886 LIN Y, JIANG S S, PAN J H, et al. Therapeutic effect of recombinant human growth hormone on the growth hormone deficiency in children with different bone age[J]. Chinese Journal of General Practice, 2019, 17(7): 1146-1149. doi: 10.16766/j.cnki.issn.1674-4152.000886
[12]	王会丽. 观察重组人生长激素治疗特发性矮小症儿童的临床疗效及对胰岛素样生长因子的影响[J]. 包头医学, 2020, 44(1): 34-36. https://www.cnki.com.cn/Article/CJFDTOTAL-BTYI202001017.htm WANG H L. Observe the clinical effect of recombinant human growth hormone on children with idiopathic short stature and effect on insulin-like growth factor[J]. Journal of Baotou Medicine, 2020, 44(1): 34-36. https://www.cnki.com.cn/Article/CJFDTOTAL-BTYI202001017.htm
[13]	王娟娟. 重组人生长激素治疗儿童生长激素缺乏症和特发性矮小症的临床效果分析[J]. 中国社区医师, 2019, 35(18): 46, 49. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS201918030.htm WANG J J. Clinical analysis of recombinant human growth hormone in the treatment of children with growth hormone deficiency and idiopathic short stature[J]. Chinese Community Doctors, 2019, 35(18): 46, 49. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS201918030.htm
[14]	HE J S, LIAN C W, ZHOU H W, et al. The correlation of leptin/leptin receptor gene polymorphism and insulin-like growth factor-1 and their impact on childhood growth hormone deficiency[J]. Eur Rev Med Pharmacol Sci, 2016, 20(17): 3642-3647.
[15]	张英华, 颜美玲, 许宁峰. GnRHa对特发性性早熟女童治疗前后血清性激素及IGF-1水平的影响[J]. 现代诊断与治疗, 2019, 30(16): 2831-2832. https://www.cnki.com.cn/Article/CJFDTOTAL-XDZD201916046.htm ZHANG Y H, YAN M L, XU N F. Effects of GnRHa on serum sex hormone and IGF-1 levels in girls with idiopathic precocious puberty before and after treatment[J]. Modern Diagnosis & Treatment, 2019, 30(16): 2831-2832. https://www.cnki.com.cn/Article/CJFDTOTAL-XDZD201916046.htm
[16]	姚海波. 重组人生长激素注射液联合注射用曲普瑞林治疗68例青春期非生长激素缺乏身材矮小患儿的短中期随访研究[J]. 中国药物与临床, 2019, 19(6): 957-959. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201906046.htm YAO H B. Study on short and mid-term effects of recombinant human growth hormone injection combined with triptorelin injection in the treatment of 68 adolescent children with non-growth hormone-deficient short stature[J]. Chin Remed Clin, 2019, 19(6): 957-959. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201906046.htm
[17]	朱周桦, 张敏. 生长激素对于GnRHa治疗中生长过度减速的特发性中枢性性早熟女孩的远期疗效分析[J]. 系统医学, 2017, 2(10): 86-88. https://www.cnki.com.cn/Article/CJFDTOTAL-XTYX201710032.htm ZHU Z H, ZHANG M. Analysis of long-term curative effect of chondrotropic hormone in id-iopathic central precocious puberty girls with overgrowth deceleration in GnRHa treatment[J]. Systems Medicine, 2017, 2(10): 86-88. https://www.cnki.com.cn/Article/CJFDTOTAL-XTYX201710032.htm
[18]	狄云霏. 重组人生长激素联合亮丙瑞林对女童中枢性性早熟的干预效果评价[J]. 实用医药杂志, 2018, 35(9): 790-792. https://www.cnki.com.cn/Article/CJFDTOTAL-QEYY201809012.htm DI Y F. Efficacy evaluation of recombinant human growth hormones combined with leuprorelin for interventing central precoclous puberty female-children[J]. Prac J Med & Pharm, 2018, 35(9): 790-792. https://www.cnki.com.cn/Article/CJFDTOTAL-QEYY201809012.htm
[19]	王颖, 梁芙蓉. 儿童生长激素治疗前后甲状腺功能的变化[J]. 中国生育健康杂志, 2017, 28(2): 155-157. https://www.cnki.com.cn/Article/CJFDTOTAL-SYJK201702017.htm WANG Y, LIANG F R. Changes of thyroid function in children before and after treatment with growth hormone[J]. Chinese Journal of Reproductive Health, 2017, 28(2): 155-157. https://www.cnki.com.cn/Article/CJFDTOTAL-SYJK201702017.htm
[20]	黄慧, 马瑞婷, 闫哲. 雌激素在桥本氏甲状腺炎中的作用[J]. 西部医学, 2015, 27(10): 1441-1444. https://www.cnki.com.cn/Article/CJFDTOTAL-XIBU201510001.htm HUANG H, MA R T, YAN Z. Role of estrogen in Hashimoto. s thyroiditis[J]. Med J west China, 2015, 27(10): 1441-1444. https://www.cnki.com.cn/Article/CJFDTOTAL-XIBU201510001.htm
[21]	张炫炜, 张满燕, 沈红, 等. 重组人生长激素对特发性矮小儿童生长速度和糖脂代谢、骨代谢水平的影响[J]. 中国医师进修杂志, 2018, 41(10): 887-891. ZHANG X W, ZHANG M H, SHEN H, et al. Effect of recombinant human growth hormone on the growth rate. glucose and lipid metabolism and bone metabolism in children with idiopathic short stature[J]. Chinese Journal of Postgraduates of Medicine, 2018, 41(10): 887-891.