GnRHa对性早熟女童下丘脑-垂体-性腺轴的调控作用
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摘要
目的:探讨促性腺激素释放激素类似物(GnRHa)对特发性中枢性性早熟(ICPP)女童下丘脑-垂体-性腺轴(HPG轴)的调控作用。方法:选取2014年4月至2015年4月孝感市中心医院收治的符合纳入及排除标准的性早熟女童患儿84例,随机分为参照组与研究组(各42例),参照组给予西医药物常规处理,研究组给予GnRHa进行治疗,观察并分析两组患儿治疗前与治疗24个月时血清雌二醇(E_2)、促卵泡生成素(FSH)、黄体生成素(LH)的分泌水平、第二性征的变化以及临床疗效,并记录其不良反应。结果:治疗24个月时两组ICPP患儿的血清E_2、LH和FSH分泌水平的基值与峰值均分别明显低于治疗前,差异具有统计学意义(P<0.05),且治疗24个月时研究组的E_2、LH和FSH分泌水平的基值与峰值明显低于参照组,差异具有统计学意义(P<0.05)。治疗24个月时,参照组与研究组患儿的第二性征均被明显抑制,研究组患儿的月经撤退、乳房变小以及乳房TannerⅠ期均明显高于参照组,差异具有统计学意义(P<0.05),且研究组的总有效率为88.10%,显著大于参照组,差异具有统计学意义(P<0.05)。治疗过程中,研究组不良反应发生率为4.76%,明显小于参照组,差异具有统计学意义(P<0.05)。结论:GnRHa可通过抑制HPG轴而降低性激素(E_2、LH、FSH)的分泌水平,能够有效调节生长发育,抑制第二性征,对ICPP女童患儿有较好的临床治疗效果,且不良反应较小。
Objective: To investigate the regulation effect of gonadotropin releasing hormone analogue (GnRHa) on hypothalamic pituitary gonadal axis (HPG axis) in girls with idiopathic central precocious puberty (ICPP). Methods: 84 girls who met the criteria of inclusion and exclusion were selected from April 2014 to April 2015 and they were randomlydivided into control group and study group,42 cases in each group. The control group was given routine treatment of western medicine,and the study group was given GnRHa for treatment. The serum secretion levels of serumestradiol (E_2),follicle stimulating hormone (FSH),luteinizing hormone (LH) levels,the changes of secondary sex characteristics and the clinical effect of two groups were observed and analyzed before treatment and 24 months after treatment,and the adverse reactions were recorded. Results: The basal and peak levels of serum E_2,LH and FSH secretions were significantly decreased in the two groups after 24 months of treatment compared with those before treatment (P < 0. 05),and the basal and peak levels of serum E_2,LH and FSH secretions in study group were significantly lower than those of control group (P < 0. 05). After 24 months of treatment,secondary sex characteristics were significantly suppressed in both control group and study group,and the menstrual retreat,small breast and breast TannerⅠstage of the children in the study group were significantly higher than those in control group (P < 0. 05). The total effective rate in study group was 88. 10%,which was significantly higher than that of control group (P < 0. 05). In the course of treatment,the incidence of side effects of study group was 4. 76%,which was significantly smaller than that in the control group (P < 0. 05). Conclusions: GnRHa can reduce the hormones (E_2,LH,FSH) levels by inhibiting HPG axis,which can effectively regulate the growth and inhibit development of secondary sexual characteristics,with better clinical curative effect on girls with ICPPand few adverse reactions.
Objective: To investigate the regulation effect of gonadotropin releasing hormone analogue (GnRHa) on hypothalamic pituitary gonadal axis (HPG axis) in girls with idiopathic central precocious puberty (ICPP). Methods: 84 girls who met the criteria of inclusion and exclusion were selected from April 2014 to April 2015 and they were randomlydivided into control group and study group,42 cases in each group. The control group was given routine treatment of western medicine,and the study group was given GnRHa for treatment. The serum secretion levels of serumestradiol (E_2),follicle stimulating hormone (FSH),luteinizing hormone (LH) levels,the changes of secondary sex characteristics and the clinical effect of two groups were observed and analyzed before treatment and 24 months after treatment,and the adverse reactions were recorded. Results: The basal and peak levels of serum E_2,LH and FSH secretions were significantly decreased in the two groups after 24 months of treatment compared with those before treatment (P < 0. 05),and the basal and peak levels of serum E_2,LH and FSH secretions in study group were significantly lower than those of control group (P < 0. 05). After 24 months of treatment,secondary sex characteristics were significantly suppressed in both control group and study group,and the menstrual retreat,small breast and breast TannerⅠstage of the children in the study group were significantly higher than those in control group (P < 0. 05). The total effective rate in study group was 88. 10%,which was significantly higher than that of control group (P < 0. 05). In the course of treatment,the incidence of side effects of study group was 4. 76%,which was significantly smaller than that in the control group (P < 0. 05). Conclusions: GnRHa can reduce the hormones (E_2,LH,FSH) levels by inhibiting HPG axis,which can effectively regulate the growth and inhibit development of secondary sexual characteristics,with better clinical curative effect on girls with ICPPand few adverse reactions.
引文
[1]陶月红,曾碧荷,沙里夫.下丘脑-垂体-性腺轴抑制程度对中枢性性早熟女童成年预测身高的影响.中国当代儿科杂志,2015,17(10):1093-1097.
[2]吴静,雷文芬,周娇妹,等.促性腺激素释放激素类似物治疗特发性中枢性性早熟女童的临床疗效及其对下丘脑-垂体-性腺轴激素水平的影响.中国全科医学,2015,13(18):2158-2162.
[3]Lee HS,Yoon JS,Roh JK,et al.Changes in body mass index during gonadotropin-releasing hormone agonist treatment for central precocious puberty and early puberty.Endocrine,2016,54(2):497-503.
[4]祁荟桔,张学源,项蓉.中西医结合治疗女童特发性中枢性性早熟36例临床分析.天津中医药大学学报,2016,35(2):88-91.
[5]中华医学会儿科学分会内分泌遗传代谢学组.中枢性(真性)性早熟诊治指南[J].中华儿科杂志,2007,45(6):426-427.
[6]胡亚美.诸福棠实用儿科学.北京:人民卫生出版社,2002:167-168.
[7]汪培欢,施弦.曲普瑞林对特发性中枢性性早熟女童治疗作用的自身前后对照观察.中国性科学,2016,25(3):59-62.
[8]Blumenfeld Z.Investigational and experimental GnRH analogs and associated neuro-transmitters.Expert Opin Investig Drugs,2017,26(6):661-667.
[9]刘毓,江超,高爱民,等.GnRHa治疗女性中枢性性早熟疗效及安全性观察.中国妇幼保健,2016,31(10):2059-2061.
[10]金献江,罗越,吴慧平.促性腺激素释放激素类似物对特发性中枢性性早熟女童体质指数及骨代谢标志物水平的影响.中国全科医学,2016,19(9):1049-1052.
[11]马黔红.GnRH类似物的其他临床应用.实用妇产科杂志,2016,32(10):730-731.
[12]陈秋莉,李燕虹,陈红珊,等.早初潮及GnRHa治疗对月经规则性的影响.中华内分泌代谢杂志,2015,31(9):774-777.
[13]张萍,薛秀华,李锦行.促性腺激素释放激素激动剂对宫颈癌术后辅助化疗患者卵巢功能的保护作用.山东医药,2015,55(34):36-37.
[14]Hadziselimovic F,Gegenschatz-Schmid K,Verkauskas G,et al.GnRHa treatment of cryptorchid boys affects genes involved in hormonal control of the HPG Axis and Fertility.Sex Dev,2017,11(3):126-136.
[15]陈秋莉,苏喆,李燕虹,等.GnRHa治疗对中枢性性早熟和快速进展型早发育女孩体重指数的影响.中华内分泌代谢杂志,2015,31(8):690-695.
[16]汪培欢,施弦.曲普瑞林对特发性中枢性性早熟女童治疗作用的自身前后对照观察[J].中国性科学,2016,25(3):59-62.
[17]蔡锡顶,李珍,白敏,等.不同剂量促性腺激素释放激素类似物对性早熟女童下丘脑-垂体-性腺轴的影响[J].儿科药学杂志,2015,21(7):18-21..
[18]林翠兰,韦婉俭,何婉懿,等.促性腺激素释放激素类似物对特发性中枢性性早熟女童促生长素轴与生长速度的影响.中国儿童保健杂志,2016,24(1):65-68.
[2]吴静,雷文芬,周娇妹,等.促性腺激素释放激素类似物治疗特发性中枢性性早熟女童的临床疗效及其对下丘脑-垂体-性腺轴激素水平的影响.中国全科医学,2015,13(18):2158-2162.
[3]Lee HS,Yoon JS,Roh JK,et al.Changes in body mass index during gonadotropin-releasing hormone agonist treatment for central precocious puberty and early puberty.Endocrine,2016,54(2):497-503.
[4]祁荟桔,张学源,项蓉.中西医结合治疗女童特发性中枢性性早熟36例临床分析.天津中医药大学学报,2016,35(2):88-91.
[5]中华医学会儿科学分会内分泌遗传代谢学组.中枢性(真性)性早熟诊治指南[J].中华儿科杂志,2007,45(6):426-427.
[6]胡亚美.诸福棠实用儿科学.北京:人民卫生出版社,2002:167-168.
[7]汪培欢,施弦.曲普瑞林对特发性中枢性性早熟女童治疗作用的自身前后对照观察.中国性科学,2016,25(3):59-62.
[8]Blumenfeld Z.Investigational and experimental GnRH analogs and associated neuro-transmitters.Expert Opin Investig Drugs,2017,26(6):661-667.
[9]刘毓,江超,高爱民,等.GnRHa治疗女性中枢性性早熟疗效及安全性观察.中国妇幼保健,2016,31(10):2059-2061.
[10]金献江,罗越,吴慧平.促性腺激素释放激素类似物对特发性中枢性性早熟女童体质指数及骨代谢标志物水平的影响.中国全科医学,2016,19(9):1049-1052.
[11]马黔红.GnRH类似物的其他临床应用.实用妇产科杂志,2016,32(10):730-731.
[12]陈秋莉,李燕虹,陈红珊,等.早初潮及GnRHa治疗对月经规则性的影响.中华内分泌代谢杂志,2015,31(9):774-777.
[13]张萍,薛秀华,李锦行.促性腺激素释放激素激动剂对宫颈癌术后辅助化疗患者卵巢功能的保护作用.山东医药,2015,55(34):36-37.
[14]Hadziselimovic F,Gegenschatz-Schmid K,Verkauskas G,et al.GnRHa treatment of cryptorchid boys affects genes involved in hormonal control of the HPG Axis and Fertility.Sex Dev,2017,11(3):126-136.
[15]陈秋莉,苏喆,李燕虹,等.GnRHa治疗对中枢性性早熟和快速进展型早发育女孩体重指数的影响.中华内分泌代谢杂志,2015,31(8):690-695.
[16]汪培欢,施弦.曲普瑞林对特发性中枢性性早熟女童治疗作用的自身前后对照观察[J].中国性科学,2016,25(3):59-62.
[17]蔡锡顶,李珍,白敏,等.不同剂量促性腺激素释放激素类似物对性早熟女童下丘脑-垂体-性腺轴的影响[J].儿科药学杂志,2015,21(7):18-21..
[18]林翠兰,韦婉俭,何婉懿,等.促性腺激素释放激素类似物对特发性中枢性性早熟女童促生长素轴与生长速度的影响.中国儿童保健杂志,2016,24(1):65-68.