摘要
目的观察重组人生长激素(rh GH)联合来曲唑治疗男性青春期矮小的疗效及不良反应。方法回顾分析2010年9月至2017年1月福建省福州儿童医院男性青春期矮小病例55例,分为单用rh GH治疗组(rh GH组)24例和rh GH+来曲唑联合治疗组(联合组)31例。疗程均≥1年。比较骨龄增加值、骨龄别身高标准差分值(Ht SDSBA),同时观察外生殖器变化、体重指数标准差分值(BMI SDS)、糖脂代谢指标及不良反应。结果两组患儿入组时年龄分别为(12.72±0.99)岁及(12.90±1.36)岁,治疗时间分别为(1.71±0.55)年及(1.58±0.46)年(均P>0.05)。治疗期间骨龄增加速率分别为(0.96±0.27)岁/年及(0.50±0.20)岁/年(P<0.01),Ht SDSBA增加值分别为(0.89±0.50)及(1.22±0.42)(P<0.01)。两组睾丸增加值分别为(7.47±3.41)m L和(9.50±3.12)m L(P>0.05)。治疗前后两组BMI SDS及糖脂代谢指标组间差异均无统计学意义。联合组治疗期间有3例发生骨折,超声骨密度检查显示骨强度严重不足,补充骨化三醇及碳酸钙后,骨强度3~6个月内逐渐增加,未再出现骨折。结论 rh GH联合来曲唑治疗男性青春期矮小可明显抑制骨龄进展,改善Ht SDSBA,不影响正常性发育,但可能对骨强度造成影响,需密切随访钙磷代谢相关指标。
Objective To explore the therapeutic effects and adverse reactions of a combination treatment of recombinant human growth hormone(rh GH)with letrozole,compared with rh GH alone,in short pubertal boys.Methods Fifty-five short pubertal boys were divided into two groups,one group was treated with rh GH(rh GH group,n=24),and the other group was treated with the combination of rh GH and letrozole(combination group,n=31).All boys had completed the over one year of treatment.The advancement of bone age(BA),height standard deviation score by bone age(Ht SDSBA),body mass index standard deviation(BMI SDS),glucose and lipid metabolism,and the changes of the external genitalia and adverse reactions were evaluated.Results The age of two groups was(12.72±0.99)years and(12.90±1.36)years,respectively(P>0.05).The treatment periods were(1.71±0.55)years and(1.58±0.46)years,respectively(P>0.05).Their BA increased(0.96±0.27)years/year and(0.50±0.20)years/year during treatment,respectively(P<0.01).Their Ht SDSBAincreased(0.89±0.50)and(1.22±0.42)(P<0.01)and testicular size increased(7.47±3.41)m L and(9.50±3.12)m L(P>0.05)respectively during treatment.There were no statistically significant difference in BMI SDS,glucose or lipid metabolism between the two groups.Three boys in combination group suffered from fractures during the treatment.Ultrasound bone density scan showed serious shortage of bone mineral density;after supplemental calcium and calcitriol,bone density increased within 3 to 6 months,and there was no recurrence of fracture.Conclusion Combination of rh GH and letrozole in short pubertal boys could inhibit BA progression and ameliorate HtSDSBA,without affecting the normal sexual development,but bone density may be affected,and long-term follow-up is needed.
作者
张莹
陈瑞敏
杨晓红
袁欣
林祥泉
ZHANG Ying;CHEN Rui-min;YANG Xiao-hong(Department of Endocrinology,Fuzhou Chil?dren’s Hospital of Fujian Province,the Teaching Hospital of Fujian Medical University,Fuzhou 350005,China)
出处
《中国实用儿科杂志》
CSCD
北大核心
2019年第9期775-779,共5页
Chinese Journal of Practical Pediatrics
基金
福州市临床重点专科建设项目经费资助项目(201610191)
关键词
来曲唑
矮小症
青春期
重组人生长激素
letrozole
short stature
puberty
recombinant human growth hormone
