特发性中枢性性早熟女童血清抑制素的浓度变化

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目的了解特发性中枢性性早熟(ICPP)女童在促性腺激素释放激素类似物(GnRHa)治疗前、后血清抑制素的变化,探讨血清抑制素在ICPP的诊断和GnRHa治疗疗效监测中的作用。方法129例(6~9岁)性早熟女童根据第二性征的发育情况,结合骨龄、盆腔B超及促性腺激素释放激素(GnRH)激发试验结果,将其分为ICPP和单纯乳房早发育(PT),并以6~9岁青春前期的健康女童作为对照组,采用ELISA法测定性早熟女童及青春前期女童的血清抑制素A和抑制素B水平,并对29例ICPP儿童进行GnRHa治疗,治疗6个月后再次复查血清抑制素A、抑制素B。结果(1)ICPP组的血清抑制素B为52.73ng/L,PT组为32.00ng/L,对照组为8.95ng/L,3组比较差异有统计学意义(P<0.05)。而血清抑制素A在ICPP组、PT组、对照组分别为5.67,5.03,7.55ng/L,3组比较差异无统计学意义(P>0.05)。(2)ICPP组,TannerⅢ期的抑制素A7.72ng/L、抑制素B79.60ng/L明显高于TannerⅡ期(抑制素A:4.91ng/L、抑制素B:32.82ng/L),两者比较差异有统计学意义(均P<0.05)。且TannerⅡ期的抑制素B与LH峰值、骨龄存在着正相关,rs分别为0.39,0.38,均P<0.05;TannerⅢ期的血清抑制素A与LH峰值、骨龄存在着正相关,rs分别为0.42,0.40,均P<0.05。(3)ICPP女童经GnRHa治疗6个月后,血清抑制素A由治疗前的7.72ng/L下降到4.12ng/L,抑制素B由92.63ng/L下降到26.97ng/L,经配对t检验,差异有统计学意义(均P<0.05)。结论ICPP女童血清抑制素随着下丘脑垂体性腺轴的变化而变化,血清抑制素尤其抑制素B可作为中枢性性早熟诊断的辅助指标,同时可作为GnRHa治疗ICPP疗效监测的指标。 Objective To investigate the changes of serum statins in girls with idiopathic central precocious puberty (ICPP) before and after gonadotropin-releasing hormone analogue (GnRHa) treatment and to explore the role of serum inhibin in the diagnosis of ICPP and the monitoring of therapeutic effect of GnRHa . Methods 129 girls (6 ~ 9 years old) with precocious puberty were divided into two groups based on the development of second sexual characteristics, bone age, pelvic ultrasound and gonadotropin-releasing hormone (GnRH) (PT). Serum inhibin A and inhibin B levels were determined by ELISA in healthy pre-adolescent girls aged 6 ~ 9 years. The 29 cases of ICPP children were treated with GnRHa Serum inhibin A and inhibin B were re-examined after 6 months of treatment. Results (1) Serum inhibin B was 52.73ng / L in ICPP group, 32.00ng / L in PT group and 8.95ng / L in control group. There was significant difference between the three groups (P <0.05). However, serum inhibin A levels were 5.67, 5.03 and 7.55 ng / L in ICPP group, PT group and control group, respectively. There was no significant difference between the three groups (P> 0.05). (2) Compared with TannerⅡphase (inhibin A: 4.91ng / L and inhibin B: 32.82ng / L), the level of inhibin A7.72ng / L and inhibin B79.60ng / The difference was statistically significant (P <0.05). There was a positive correlation between statin B in TannerⅡand LH and bone age (rs = 0.39 and 0.38, respectively, P <0.05). Serum inhibin A was positively correlated with peak LH and bone age in Tanner Ⅲ (rs = 0.42 , 0.40, all P <0.05. (3) Six months after GnRHa treatment in ICPP girls, serum inhibin A decreased from 7.72 ng / L before treatment to 4.12 ng / L, while inhibin B decreased from 92.63 ng / L to 26.97 ng / L after paired t Test, the difference was statistically significant (P <0.05). Conclusions ICPP girls’ serum inhibin changes with the change of hypothalamic pituitary gland axis. Serum inhibin, especially inhibin B, can be used as an auxiliary index for the diagnosis of central precocious puberty and can be used as an indicator of therapeutic effect of GnRHa on ICPP.
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