连 群 蒋清斌 李伶俐 许珊珊 连珠兰

来曲唑联合生长激素治疗青春期生长激素缺乏症男孩对成年身高的影响

连 群 蒋清斌 李伶俐 许珊珊 连珠兰

目的 比较来曲唑联合基因重组人生长激素（rhGH）与单用rhGH对青春期生长激素缺乏症（GHD）男孩的治疗效果。观察治疗前后生长速率（GV）、骨龄（BA）、预测成年身高（PAH）和骨龄的身高标准差积分（HtSDSBA）变化，及来曲唑对血脂、性激素的影响。方法 选取2010年10月～2014年1月，厦门大学附属第一医院儿科内分泌专科50例青春期GHD男孩，随机分为两组，A组20例单用rhGH，B组30例来曲唑联合rhGH，疗程2年。结果 治疗后B组GV、PAH、HtSDSBA较A组提高，BA较A组减慢，差异有统计学意义。B组治疗后胆固醇（CHO）、甘油三酯（TG）、高密度脂蛋白（HDL-C）与治疗前比较，差异无统计学意义；低密度脂蛋白（LDL-C）较治疗前升高（P＜0.05）；停药3个月与治疗后比较，LDL-C回落（P＜0.001）。而A组治疗后、停药后血脂与治疗前比较差异无统计学意义。A、B两组治疗前雌二醇（E2）、睾酮（T）差异无统计学意义，治疗后B组T较治疗前升高，亦较A组升高（P＜0.05）。停药后3个月与治疗后比较，E2回升（P＜0.05）、T降低（P＜0.001）。结论 来曲唑联合rhGH治疗青春期GHD患儿，能更好地提高PAH，安全性及耐受性良好，对血脂及性激素的影响为可逆性。

生长激素缺乏症；青春期；来曲唑

doi：10.3969/j.issn.1674-9316.2016.13.066

【Abstract】

Objective Comparison of the treatment of adolescent growth hormone deficiency（GHD） boy by using Letrozole and rhGH or rhGH. Observed Growth velocity（GV），bone age（BA），predict adult height（PAH） and the height of BA standard deviation integral（HtSDSBA） before and after treatment，and what influence letrozole brought to blood lipids，sex hormones. Methods Selected 50 cases of puberty GHD boy from October 2010 to January 2014，randomly divided into two groups. Group A（A）of 20 cases with GH therapy，Group B（B） of 30 cases with letrozole and GH. Treatment for 2 years. Results Finished treatment，GV，PAH，HtSDSBA in B were higher than in A. BA in B grew more slowly than in A，the difference had statistically significant. Group B after treatment of cholesterol（CHO），triglycerides（TG），high-density lipoprotein（HDL-C）compared with before treatment，there was no statistically significant difference. LDL-C was higher than before（P＜0.05）. Stopped treatment 3 months VS finished treatment，LDL-C went down（P＜ 0.001）. Blood lipid in A had no different comparing stopped treatment to finished treatment. Before treatment E2& T in both groups had no different，but after finished treatment，T in B was higher than before and A. Stopped treatment 3 months VS finished treatment，E2was higher（P＜0.05），T was lower（P＜0.001）. Conclusion AI for children with rhGH treatment of adolescent GHD can improve better PAH. Safe and well tolerated，has reversible effects on blood lipid and sex hormones.

【Key words】Growth hormone deficiency，Adolescence，Letrozole

生长激素缺乏症（GHD）为身材矮小常见原因，由于腺垂体合成和分泌GH部分或完全缺乏，或由于GH分子结构异常、受体缺陷，身高低于同年龄同性别平均数减两个标准差［1］，1985年美国FDA批准rhGH治疗GHD。研究发现，年龄小者效果较好，治疗效应与剂量相关；对已性发育、具有较大骨龄的青春期GHD男孩单用rhGH改善终身高效果不确切。……