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目的探讨月缓释型促性腺激素释放激素类似物(Gn RHa)注射后1 h血黄体生成素(LH)浓度检测对于Gn RHa治疗中枢性性早熟(CPP)女孩性腺轴功能抑制的意义。方法 2009年1月至2014年1月舟山市妇幼保健院20例CPP女孩,均经Gn RH激发试验明确诊断后,予Gn RHa治疗6~24个月。20例儿童在Gn RHa治疗前均已接受Gn RH激发试验。14例治疗第3针前或后再做Gn RH激发试验。20例儿童均于Gn RHa注射后1 h检测血LH浓度。比较LH值与临床发育受抑情况(包括发育分期、骨龄和生长速率);同时评估LH值对CPP女孩Gn RHa治疗的监测作用。结果 19/20例女孩治疗有效。治疗前Gn RH激发试验LH峰值为(13.8±5.7)U/L(7~24.5 U/L)。治疗3针后Gn RH激发试验LH峰值水平为(1.2±0.5)U/L(0.6~2.0 U/L)。首次Gn RHa注射后1 h检测血LH浓度为(21.7±7.3)U/L(10.0~35.3 U/L)。注射第3针后1 h检测血LH浓度(1.4±0.6)U/L(0.5~2.5 U/L)。1例儿童治疗3针后乳房发育及生长速率未得到有效控制,其注射第3针后1 h血LH浓度为4.5 U/L。结论 Gn RH激发试验后LH峰值小于2.0 U/L,或Gn RHa注射后1 h血LH浓度低于2.5 U/L可能有助于监测Gn RHa治疗的有效性。后者可能是代替Gn RH激发试验的可靠、便捷的方法。
Objective To investigate the significance of detecting blood LH level 1 h after Gn RHa injection for inhibiting the gonadal axis function of Gn RHa in central precocious puberty (CPP) girls. Methods From January 2009 to January 2014, 20 cases of CPP girls from Zhoushan Maternal and Child Health Care Hospital were treated with Gn RHa for 6-24 months after they were diagnosed by Gn RH provocation test. Twenty children underwent Gn RH challenge before Gn RHa treatment. Gn RH challenge test was performed before or after treatment of the third needle in 14 cases. All 20 children were tested for blood LH level 1 hour after Gn RHa injection. To compare the LH value and the clinical development of depression (including developmental stage, bone age and growth rate); at the same time to assess the LH value of CPP treatment of Gn RHa girl. Results 19/20 girls treated effectively. The LH peak value of Gn RH test before treatment was (13.8 ± 5.7) U / L (7-24.5 U / L). The LH peak value of Gn RH challenge test was (1.2 ± 0.5) U / L (0.6-2.0 U / L) after 3 treatments. The blood LH level after the first Gn RHa injection was (21.7 ± 7.3) U / L (10.0 ~ 35.3 U / L). Blood LH concentration (1.4 ± 0.6) U / L (0.5-2.5 U / L) was measured at 1 hour after injection of the third needle. The breast development and growth rate were not effectively controlled in 1 child after 3 treatments. The blood LH concentration was 4.5 U / L at 1 h after injection of the third needle. Conclusions LH peak value less than 2.0 U / L after Gn RH challenge test or blood LH level less than 2.5 U / L at 1 h after Gn RHa injection may be helpful in monitoring the effectiveness of Gn RHa treatment. The latter may be a reliable and convenient alternative to the Gn RH challenge test.