目的 观察小剂量雌激素联合促性腺激素释放素类似物(GnRHa)治疗特发性中枢性性早熟(ICPP)的效果.方法 45例ICPP伴生长减速患儿分为3组:雌激素联合GnRHa治疗组、重组人生长激素(rhGH)联合GnRHa治疗组、单纯GnRHa治疗组,每组15例.分别于治疗前和治疗6个月后观察3组患儿骨龄(BA)、年生长速率(GV)、体质量、身高(Ht)、骨龄身高(Htba)、成年预测身高(PAH)、血脂、血糖、胰岛素、甲状腺功能、雌二醇(E2)、睾酮(T)、泌乳素(PRL)、血胰岛素样生长因子1(IGF-1)、乳房及子宫卵巢B超等的变化；另行GnRH激发试验监测促黄体生成素(LH)和促卵泡雌激素(FSH)水平.结果 3组患儿治疗前Ht、Htba、骨龄/年龄(BA/CA)、PAH、GV、体质量、IGF-1比较差别均无统计学意义(P＞0.05).治疗6个月后,雌激素联合GnRHa治疗组患儿GV、Ht、PAH明显高于治疗前(P＜0.05),rhGH联合GnRHa治疗组患儿GV.、Ht、PAH、IGF-1明显高于治疗前(P＜0.05)；且雌激素联合GnRHa治疗组和rhGH联合GnRHa治疗组患儿GV、Ht、PAH明显高于单纯GnRHa治疗组(P＜0.05)；rhGH联合GnRHa治疗组患儿IGF-1明显高于雌激素联合GnRHa治疗组和单纯GnRHa治疗组(P＜0.05).3组治疗前后E2、T、PRL、乳房及子宫和卵巢B超结果均无明显变化,GnRH激发试验LH、FSH和LH/FSH亦无明显变化(P＞0.05).结论 小剂量雌激素联合GnRHa治疗ICPP,能在不加速BA的情况下有效地提高生长速率,且雌激素价格便宜,患者依从性好.%Objective To assess the effect of combined treatment of minidose estrogen and gonadotropin releasing hormone analogues (CnRHa) for children with idiopathic central precocious puberty (ICPP). Methods Forty-five female patients with ICPP and growth deceleration were divided into three groups:estrogen plus GnRHa group,recombinant human growth hormone (rhGH) plus GnRHa group and GnRHa group, fifteen patients in each group. The bone age (BA ) , growth velocity (GV), weight, height (Ht) .height for bone age(Htba) .predicting adult height (PAH) .blood fat, blood glucose, insulin, thyroid function, oestriol(E2) ,testosterone(T),prolactin(PRL),insulin-like growth factor-1 (IGF-1) .breast,ultrasound examination of u-terus and ovary were observed before treatment and six months after treatment in the three groups. The levels of luteinizing hor-mone( LH) and follicle-stimulating hormone( FSH) were detected with GnRH provocation test. Results There was no significant difference in the level of Ht,Htba,BA/CA,PAH,GV,weight and IGF-1 among three groups before treatment(P >0.05). Six months after treatment, GV,Ht and PAH of estrogen plus GnRHa group were significantly higher(P <0.05) ,and GV,Ht,PAHand IGF-1 of rhGH plus GnRHa group were significantly higher( P < 0.05 ). Six months after treatment, GV, Ht and PAH of estrogen plus GnRHa group and rhGH plus GnRHa group were significantly higher than those of GnRHa group(p<0.05) ,and IGF-1 of rhGH plus GnRHa group was significantly higher than that of estrogen plus GnRHa group and GnRHa group (P <0.05). In the three groups,there were no significant difference in E2 ,T,PRL,breast,ultrasound examination of uterus and ovary before and after treatment(P>0.05).The level of LH,FSH and FSH/LH which responses to GnRH stimulation test were no difference in three groups (P>0.05). Conclusion Combined treatment of minidose estrogen and GnRHa can improve the GV without the act of acceleration in BA.and this therapy is cheaper and has good compliance to chilren with ICPP.
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