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目的:观察不同剂量促性腺激素释放激素类似物(Gn RHa)缓释剂对特发性中枢性性早熟(ICPP)或快速进展型早发育(EFP)女童下丘脑-垂体-性腺轴(HPGA)的影响。方法:26例ICPP和10例EFP女童预先给予Gn RHa(曲普瑞林或亮丙瑞林)每次100μg/kg,最大剂量3.75 mg皮下注射,每4周一次,治疗12周(给药3次)后按体质量分为低剂量组(体质量<30 kg)20例和高剂量组(体质量≥30 kg)16例。低剂量组Gn RHa剂量改为每次1.88 mg,高剂量组Gn RHa剂量改为每次80μg/kg,最大剂量3.75 mg,两组均根据LHRH激发试验LH峰值及临床受抑制情况调整剂量,每4周给药一次。随访1年,于治疗前及治疗后3、6、12个月复查LHRH激发试验,并观察发育抑制情况。结果:两组治疗前LH基值及峰值比较差异无统计学意义(P>0.05)。低剂量组治疗3个月后LH峰值均<2 IU/L,治疗6个月后有2例LH峰值>2 IU/L(及时调整剂量),治疗12个月后LH峰值均<2 IU/L;高剂量组治疗3个月后2例LH峰值>2 IU/L,予最大剂量3.75 mg治疗,仍有1例在治疗后6、12个月复查时LH峰值>2 IU/L,发育未完全抑制;两组其他女孩均表现为乳房肿块消退,骨龄增长受抑,生长速率降至发育前水平。结论:按患儿体质量应用不同剂量的Gn RHa治疗ICPP或EFP女童,均能有效抑制HPGA,提高患儿预测终身高。但在实际治疗过程中,需遵循个体化用药原则调整剂量。
OBJECTIVE: To observe the hypothalamic-pituitary-gonadal axis (HPGA) of girls with idiopathic central precocious puberty (ICPP) or rapid progressive early development (EFP) with different dosages of GnRa sustained- Impact. METHODS: Twenty-six female ICPPs and 10 female EFPs were given Gn RHa (triptorelin or leuprorelin) 100 μg / kg each time and the maximum dose was 3.75 mg injected subcutaneously once every four weeks for 12 weeks (administration 3 Times) were divided into low dose group (body mass <30 kg) and high dose group (body mass ≥30 kg) according to body weight. The dose of Gn RHa in low dose group was changed to 1.88 mg each time, and the dose of Gn RHa in high dose group was changed to 80 μg / kg each time and the maximum dose was 3.75 mg. The dosage of Gn RHa was adjusted according to the LH peak of LHRH provocation test and clinical inhibition. Administered once every 4 weeks. The patients were followed up for 1 year. LHRH provocation test was performed before treatment and at 3, 6 and 12 months after treatment, and the developmental inhibition was observed. Results: There was no significant difference between the two groups in baseline LH and before treatment (P> 0.05). The LH peak value was less than 2 IU / L after 3 months of treatment in low-dose group, and 2 cases of LH peak> 2 IU / L after 6 months of treatment (adjusted dose in time) L; LH dose> 2 IU / L in 2 cases after high-dose treatment for 2 months and maximum dose of 3.75 mg, and still 1 case had LH peak> 2 IU / L at 6 and 12 months after treatment Not completely inhibited; the other two groups of girls showed signs of regression of breast lumps, suppression of bone age growth, growth rate decreased to pre-developmental level. Conclusion: Applying different dosages of Gn RHa to ICP girls or EFP girls according to the body weight of children can effectively inhibit HPGA and improve the predictive final height of children. However, in the actual treatment process, the need to follow the principle of individual medication dose adjustment.