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【目的】前瞻分析中枢性性早熟(central precocious puberty,CPP)患儿在促性腺激素释放激素拟似物(gonadotropin releasing hormone agonist,GnRHa)治疗中出现生长减速时司坦唑醇(stanozolol,ST)对克服减速的疗效。【方法】分析特发性CPP并接受了曲普瑞林治疗的女性患儿30例,分3组,①单独GnRHa组;②GnRHa+ST组;③GnRHa+生长激素(growth hormone,GH)组。按生长速度、骨龄(bone age,BA)配对。达菲林50~100μg/kg,每隔28 d一次。ST30μg/(kg.d),连续服用3个月后停3个月;GH剂量1 U/kg.w,分6~7次,睡前皮下注射。比较研究前后生长速度、BA、按骨龄判断的身高标准差分值(HtSDSba)、预测成年身高(PAH)、按遗传靶身高的预测成年身高标准差分值(PAHSDSTHt)。【结果】①单独GnRHa组研究前后生长速度未见改变,GnRHa+ST组和GnRHa+GH组均较加药前生长速度加快;②单独GnRHa治疗的患儿研究期间HtSDSba未见明显改善,而经过ST、GH治疗后HtSDSba均明显改善。△HtSDSba组间比较,GnRHa+ST组显著高于单独GnRHa组及GnRHa+GH组,GnRHa+GH组亦显著高于单独GnRHa组;③单独GnRHa治疗组PAH未见明显改善,而经过ST、GH治疗后PAH明显改善。△PAH组间比较,GnRHa+ST组显著高于单独GnRHa组,GnRHa+GH组高于单独GnRHa组,GnRHa+ST组与GnRHa+GH组比较无明显差异。【结论】GnRHa能抑制中枢性性早熟患儿骨龄的增长,但在治疗过程中可能出现生长减速;对骨龄相对较大的患儿,应用司坦唑醇能显著改善生长速度,提高预测成年身高。远期的对成年终身高影响尚需进一步观察。
【Objective】 To prospectively analyze the effect of stanozolol (ST) on the growth of patients with central precocious puberty (GOPH) after gonadotropin releasing hormone agonist (GnRHa) To overcome the effect of deceleration. 【Methods】 Thirty women with idiopathic CPP who received triptorelin treatment were divided into three groups: ① GnRHa alone; ② GnRHa + ST; ③GnRHa + growth hormone (GH) group. According to the growth rate, bone age (bone age, BA) paired. Tamiflu 50 ~ 100μg / kg, once every 28 d. ST30μg / (kg.d), taking 3 months after continuous withdrawal for 3 months; GH dose of 1 U / kg.w, 6 to 7 times, subcutaneous injection before bedtime. The growth rate before and after the study, BA, height difference (HtSDSba) based on bone age, predicted adult height (PAH), and predicted adult height standard deviation (PAHSDSTHt) based on genetic target height were compared. 【Results】 ① The growth rate of GnRHa group was not changed before and after the study. The growth rate of GnRHa + ST group and GnRHa + GH group was faster than that of before GnRHa treatment group; ② HtSDSba did not improve obviously in the GnRHa group alone, HtSDSba significantly improved after ST and GH treatment. △ HtSDSba group, GnRHa + ST group was significantly higher than GnRHa alone and GnRHa + GH group, GnRHa + GH group was significantly higher than GnRHa alone group; ③ GnRHa alone treatment group, no significant improvement in PAH, and after ST, GH After treatment PAH significantly improved. △ PAH group, GnRHa + ST group was significantly higher than GnRHa alone group, GnRHa + GH group was higher than GnRHa alone group, GnRHa + ST group and GnRHa + GH group no significant difference. 【Conclusion】 GnRHa can inhibit the growth of skeletal age in children with central precocious puberty but may slow down in the process of treatment. Stanozolol can significantly improve the growth rate and improve the prediction of adult height in children with relatively high skeletal age . Long-term effects on adult life-long high need to be further observed.