| Bankground and Objective:Gonadotropin-releasing hormone analogue (GnRHa) significantly improved the adult hight of early central precocious puberty in children [1]. However, due to lack of knowledge of precocious puberty, some patients missed the best time for treatment, resulting in predicted adult height in girls<150cm, boy<160cm or HtSDSBA<-2. The purpose of this study is to observe the effect on height improvement treated with GnRHa and recombinant human growth hormone (rhGH) in patients with large bone age of idiopathic central precocious pubertyThe patients and the method:Patients:30 girls of ICPP whose BA>=11.5years from pediatric endocrinologist Out-patient Department of Shandong Provincial Hospital between Mar 2008 and Mar 2011, treated time more than 12 months.Treatments:combination therapy with rhGH and GnRHa:GnRHa 80-100μg/ kg(maximum 3.75mg), every 4 weeks, im, except the first interval of 2 weeks; with rhGHO.14～0.20IU/kg.d, ih, every night before sleepObservation index:All children are measured height (H), weight (WT), bone age (BA), BMI (body mass index), PAH (predicted adult height), HtSDSBA (height standard deviation score for the bone age), HtSDScA (height standard deviation score for chronological age), GV(growth velocity)every 3 months. Ovary and uterus were examined by ultrasonography in all girls, fasting test of LH, FSH, E2, T, PRL, thyroid function, electrolytes, liver and kidney function,and GnRHa stimulation test were evaluated.Height, weight, bone age, related hormone levels were followed up every 3 months, the hypothalamus-pituitary MRI were done in all girls with rapid progress of Secondary sexual characteristicsResults:H:after combination therapy with GnRHa and rhGH, the mean height at the 3,6,9,12 months was respectively (144.40±3.30)cm, (147.50±3.97)cm, (149.56±4.76)cm,(152.13±4.80)cm, the mean height at 6,9 and 12 months were significantly increased when compared with that of pretreatment(respectively P<0.05,0.05,0.01).GV:after receiving combination therapy for the first 3 months,the GV was 11.36±1.40cm, which was significantly increased (P<0.01)compared with the beginning before treatment; however, no significant difference were observed at the 6,9,12 months when compared with that of pretreatment。Ht-SDS:HtSDSBA increased significantly after treatment of 9(P<0.05),12 (P <0.01)months. There were no significant changes in HtSDScA after treatment;PAH:Mean TH was (156.43±1.99)cm, mean PAH was (149.56±4.18)cm, PAH-TH was (-6.87±4.45)cm before treatment, the mean PAH significantly improved at the 9 (P<0.05),12 (P<0.01) months after treatment when compared with pretreatment. PAH-TH values were significantly increased after receiving combination therapy for 6 (P<0.05),9 (P<0.05),12 (P<0.05) months.BMI:the mean BMI after treatment of 3,6,9,12 months had no significant difference compared with pretreatment。 Correlation:1) After treatment,there was a significant positive linear correlation between increased height(△Ht) and treatment time(r=0.95,P=0.00).2) After treatment,there was a significant positive linear correlation between the HtSDSBA and treatment time(r=0.65, P=0.00).3) After treatment,there was a significant positive linear correlation between the PAH and treatment time(r=0.673, P=0.00).4) After treatment,there was a significant positive linear correlation between the△PAH and treatment time(r=0.937, P=0.00).5) After treatment,there was a significant positive linear correlation between the PAH-TH and treatment time(r=0.62, P=0.00).Conclusion:1) The Combination therapy with GnRHa and rhGH can significantly improve the PAH in girls with big bone age of idiopathic central precocious puberty; the longer treatment,the better height increament2) GV accelerated at the first 3 months,normal growth rate thereafter。3) There were no significant effect on BMI after Combination therapy... |
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