中国临床药学杂志

目的 探究重组人生长激素联合曲普瑞林对特发性中枢性早熟女童卵巢功能及骨代谢指标[骨钙素N端中分子片段（N-MID）、Ⅰ型前胶原氨基端肽（PINP）、Ⅰ型胶原羧基端肽β特殊序列（β-CTX）]水平的影响。方法 前瞻性选择2021年2月至2022年3月医院收治的80例特发性中枢性早熟女童为研究对象，采用随机数字表法将其分为常规组（40例，接受曲普瑞林治疗）和联合组（40例，接受曲普瑞林联合重组人生长激素治疗）。治疗48周后，对比2组患者生长情况[观察指标为预测成人身高、骨龄差值/年龄差值（ΔBA/ΔCA）、身体质量指数和年平均生长速度（ΔGV）]，骨代谢指标（N-MID、PINP、β-CTX），卵巢功能[卵巢体积、子宫体积及性激素促黄体素（LH）、卵泡刺激素（FSH）和雌二醇（E2）水平]及临床疗效。结果 治疗后，联合组患者预测成人身高和ΔGV均高于常规组，而ΔBA/ΔCA低于常规组，差异均有高度统计学意义（P<0.01）；联合组患者β-CTX水平高于常规组，而N-MID、PINP水平则低于常规组，差异均具有高度统计学意义（P<0.01）；联合组患者卵巢体积、子宫体积及LH、FSH、E2水平均低于常规组，差异有高度统计学意义（P<0.01）。联合组治疗总有效率高于常规组，差异有统计学意义（92.50%vs75.00%,P<0.05）；而不良反应总发生率与常规组比较，差异无统计学意义（27.50%vs15.00%,P>0.05）。结论 重组人生长激素联合曲普瑞林可降低特发性中枢性早熟女童N-MID水平，延缓卵巢发育，治疗效果显著。

AIM To investigate the impacts of recombinant human growth hormone combined with triptorelin on ovarian function and levels of bone metabolism indicators [N-terminal middle osteocalcin(N-MID), procollagen type I N-terminal peptide(PINP), β-isomerized carboxy-terminal telopeptides collagen type I(β-CTX)] in girls with idiopathic central precocious puberty. METHODS Using a prospective study approach, 80 girls with idiopathic central precocious puberty admitted to Zunhua People's Hospital from February 2021 to March 2022 were selected as the research subjects.A randomized numerical table method was used to divide them into the conventional group(40 patients, treated with triptorelin) and the combination group(40 patients, treated with recombinant human growth hormone and triptorelin).After 48 weeks of treatment, the 2 groups were compared regarding predicted adult height, bone age difference/chronological age difference(ΔBA/ΔCA), annual average growth velocity(ΔGV), bone metabolism indicators(N-MID,PINP, β-CTX), ovarian function[ ovarian and uterine volume, luteinizing hormone(LH), follicle stimulating hormone(FSH)and estradiol(E2) levels], and clinical efficacy. RESULTS After treatment, the predicted adult height and ΔGV in the combined group were higher than those in the conventional group. At the same time, ΔBA/ΔCA was lower than that in the conventional group, and the difference was highly statistically significant(P < 0.01). The level of β-CTX in the combined group was higher than that in the conventional group, while the levels of N-MID and PINP were lower than those in the conventional group, and the differences were highly statistically significant(P < 0.01). The ovarian volume, uterine volume and levels of LH, FSH and E2 in the combined group were lower than those in the conventional group, and the differences were highly statistically significant(P < 0.01). The total effective rate of treatment in the combined group was higher than that in the conventional group, and the difference was statistically significant(92.50 % vs 75.00 %, P < 0.05).There was no significant difference in the total incidence of adverse reactions between the 2 groups(27.50 % vs 15.00 %,P > 0.05). CONCLUSION Recombinant human growth hormone combined with triptorelin can reduce N-MID levels in girls with idiopathic central precocious puberty, delay ovarian development, and has shown an obvious therapeutic effect.