中枢性性早熟女童治疗过程中维生素D浓度的变化及意义(1)
[摘要]目的 观察中枢性性早熟(CPP)女童在使用促性腺激素释放激素类似物(GnRHa)治疗前后维生素D浓度的变化及其意义。方法 选取2014年1月～2017年9月我院收治的CPP女童49例为研究组，另选同期健康体检的49例正常女童作为对照组。分别检测两组维生素D水平，并根据维生素D水平将研究组分为研究Ⅰ组(Vit D正常)与研究Ⅱ组(Vit D缺乏)。观察比较研究组两组在使用GnRHa治疗前后维生素D浓度的变化，并分析其临床意义。结果 研究组患儿的维生素D水平明显低于对照组，其中研究Ⅱ组的维生素D水平又明显低于研究Ⅰ组，差异均有统计学意义(P<0.05)。治疗6个月后，研究Ⅰ、Ⅱ组的维生素D水平均有所下降，且研究Ⅱ组治疗后的维生素D水平明显低于研究Ⅰ组，差异有统计学意义(P<0.05)。研究Ⅰ组女童GnRHa治疗后的乳房发育停止或消退比例明显高于研究Ⅱ组，差异有统计学意义(P<0.05)。结论 CPP患儿的维生素D水平普遍偏低，且应用GnRHa治疗过程中会使维生素D水平降低，而维生素D水平对临床GnRHa治疗乳房发育消退的效果存在一定的影响，因此补充充足的维生素D是非常必要的。
[关键词]中枢性性早熟；维生素D；雌二醇；临床意义
[中图分类号] R725.8 [文献标识码] A [文章编号] 1674-4721(2018)7(b)-0107-03
[Abstract] Objective To observe the changes and significance of vitamin D concentration in girls with central precocious puberty (CPP)before and after treatment with gonadotropin releasing hormone analogue. Methods From January 2014 to September 2017， 49 girls with CPP were selected as study group. And another 49 healthy girls were selected as control group. The vitamin D levels in two groups were measured， and the study group was divided into two groups according to the vitamin D level：study group Ⅰnormal Vit D and study group Ⅱ with Vit D deficiency. The changes of vitamin D concentration in two groups before and after treatment with GnRHa analogue were observed and compared. And the clinical significance was analyzed. Results The level of vitamin D in the study group was significantly lower than that in the control group， and the vitamin D level in the study group Ⅱ was significantly lower than that in the study group Ⅰ (P<0.05). After 6 months of treatment， the levels of vitamin D in study group Ⅰ and group Ⅱ were all decreased， and the level of vitamin D in group Ⅱ was significantly lower than that in groupⅠ， the differences were statistically significant (P<0.05). The rate of breast development stopped or subsided after GnRHa treatment in the study groupⅠ was significantly higher than that in the study group Ⅱ(P<0.05). Conclusion Vitamin D level is generally low in children with CPP， and vitamin D level will decrease in the course of treatment with GnRHa analogue， and vitamin D level has a certain influence on the effect of clinical GnRHa in the treatment of breast development regression. Therefore， adequate vitamin D supplementation is very necessary.
[Key words] Central precocious puberty； Vitamin D； Estradiol； Clinical significance
中樞性性早熟(CPP)是指女童在8岁前，男童在9岁前呈现第二性征的发育异常性疾病[1]。CPP是缘于下丘脑提前增加了促性腺激素释放激素(GnRH)的分泌和释放量，提前激活性腺轴功能，导致性腺发育和分泌性激素，使内、外生殖器发育和第二性征呈现[2]。CPP又称为GnRH依赖性性早熟，其过程呈进行性发展，直至生殖系统发育成熟。为了改善早熟给患儿造成的成年期身高受损；防止早熟和早初潮带来的心理问题目前最推荐的治疗药物是GnRHa如曲普瑞林[3-4]。自1981年，GnRHa开始用于治疗CPP以来，很多研究证实GnRHa很少有长期的潜在的副作用，被认为是安全有效的，很少见到GnRHa治疗引起维生素D浓度降低的报道[5]。而近年来国外有研究发现维生素D与机体骨代谢、生殖功能以及女童的月经初潮年龄间存在一定的关系[6]。本研究旨在观察CPP女童在使用GnRHa类似物治疗前后维生素D浓度的变化及意义，为临床治疗提供参考，现报道如下。, http://www.100md.com(陈华琴 邓肖君 伍金华)
[关键词]中枢性性早熟；维生素D；雌二醇；临床意义
[中图分类号] R725.8 [文献标识码] A [文章编号] 1674-4721(2018)7(b)-0107-03
[Abstract] Objective To observe the changes and significance of vitamin D concentration in girls with central precocious puberty (CPP)before and after treatment with gonadotropin releasing hormone analogue. Methods From January 2014 to September 2017， 49 girls with CPP were selected as study group. And another 49 healthy girls were selected as control group. The vitamin D levels in two groups were measured， and the study group was divided into two groups according to the vitamin D level：study group Ⅰnormal Vit D and study group Ⅱ with Vit D deficiency. The changes of vitamin D concentration in two groups before and after treatment with GnRHa analogue were observed and compared. And the clinical significance was analyzed. Results The level of vitamin D in the study group was significantly lower than that in the control group， and the vitamin D level in the study group Ⅱ was significantly lower than that in the study group Ⅰ (P<0.05). After 6 months of treatment， the levels of vitamin D in study group Ⅰ and group Ⅱ were all decreased， and the level of vitamin D in group Ⅱ was significantly lower than that in groupⅠ， the differences were statistically significant (P<0.05). The rate of breast development stopped or subsided after GnRHa treatment in the study groupⅠ was significantly higher than that in the study group Ⅱ(P<0.05). Conclusion Vitamin D level is generally low in children with CPP， and vitamin D level will decrease in the course of treatment with GnRHa analogue， and vitamin D level has a certain influence on the effect of clinical GnRHa in the treatment of breast development regression. Therefore， adequate vitamin D supplementation is very necessary.
[Key words] Central precocious puberty； Vitamin D； Estradiol； Clinical significance
中樞性性早熟(CPP)是指女童在8岁前，男童在9岁前呈现第二性征的发育异常性疾病[1]。CPP是缘于下丘脑提前增加了促性腺激素释放激素(GnRH)的分泌和释放量，提前激活性腺轴功能，导致性腺发育和分泌性激素，使内、外生殖器发育和第二性征呈现[2]。CPP又称为GnRH依赖性性早熟，其过程呈进行性发展，直至生殖系统发育成熟。为了改善早熟给患儿造成的成年期身高受损；防止早熟和早初潮带来的心理问题目前最推荐的治疗药物是GnRHa如曲普瑞林[3-4]。自1981年，GnRHa开始用于治疗CPP以来，很多研究证实GnRHa很少有长期的潜在的副作用，被认为是安全有效的，很少见到GnRHa治疗引起维生素D浓度降低的报道[5]。而近年来国外有研究发现维生素D与机体骨代谢、生殖功能以及女童的月经初潮年龄间存在一定的关系[6]。本研究旨在观察CPP女童在使用GnRHa类似物治疗前后维生素D浓度的变化及意义，为临床治疗提供参考，现报道如下。, http://www.100md.com(陈华琴 邓肖君 伍金华)