促性腺激素释放激素类似物治疗对特发性中枢性性早熟女性患儿远期糖脂代谢及性腺轴功能影响观察

摘要

目的 观察促性腺激素释放激素类似物(GnRHa)治疗对特发性中枢性性早熟(ICPP)女性患儿停药后体重指数(BMI)、糖脂代谢及性腺轴功能的影响.方法 收集于2010年1月至2013年1月在福建省福州儿童医院确诊为ICPP并接受GnRHa治疗,于2012年1月至2015年1月停药的ICPP女性患儿共65例,在其停药时、停药后1年、停药后2年进行随访.比较停药后与停药时BMI、空腹血糖、血脂、胰岛素、性腺轴激素水平变化,同时B超检查子宫及卵巢容积.结果 共随访65例ICPP女性患儿,与停药时相比,停药后1年、停药后2年BMI、空腹胰岛素和性激素等指标均升高,子宫、卵巢容积增大(P＜ 0.05);BMI-Z分值、空腹血糖及脂代谢指标与停药时相比差异均无统计学意义(P＞0.05).与停药时相比,停药后2年硫酸脱氢表雄酮、睾酮升高(P＜0.05).32例于停药后(14.16±6.70)个月,(11.86±0.75)岁月经初潮.结论 GnRHa治疗停药后ICPP女性患儿性腺轴功能逐渐恢复.GnRHa治疗不影响患儿体重变化,可能引起胰岛素及雄激素水平增高.%Objective To observe the influence of gonadotropin-releasing hormone analogue (GnRHa) treatment on body mass index (BMI),glucose and lipid metabolism,hypothalamic pituitary gonadal axis (HPGA) function in Chinese girls with idiopathic central precocious puberty (ICPP) after withdrawal.Methods The girls,who were treated with GnRHa for two years and then withdrawn,were enrolled in this study.The data of height,weight,BMI,fasting blood glucose (FBG),blood lipid,insulin,serum hormones associated with the HPGA,and the volumes of uterine and ovarian were obtained and compared at withdrawal,the first and second year after withdrawal respectively.Results A total of 65 girls with ICPP were studied.Compared with withdrawal,BMI,sex hormone and other indexes at the first and second year after withdrawal were increased significantly (P ＜ 0.05),but the level of BMI-Z score,FBG and lipid metabolism index did not change significantly (P＞0.05).Dehydroepiandrosterone sulfate and testosterone at second year after withdrawal were significantly higher than those at withdrawal (P ＜ 0.05).After withdrawol for (14.16 ± 6.70) months,32 girls emerged menarche,whose average age was (11.86±0.75) years old.Conclusion HPGA function of ICPP girls who had treated with GnRHa gradually recovered after withdrawal.The treatment of GnRHa has been found no influence on weight status,but might increase the level of insulin and androgen.