对GnRHa单疗法与GnRHa单疗法的比较疗效 对于中部早期青春期的组合疗法:系统审查和元分析
Chang-En Tsai1, Hsien-Yu Fan2, Meng-Che Tsai3
1School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
The Journal of clinical endocrinology and metabolism
|November 12, 2025
概括
增长激素组合疗法显著改善了中部早发性青春期 (CPP) 的儿童的身高结果,而不是单独使用激素释放激素类似物 (GnRHa). 对于其他疗法和特定患者群体需要进一步的研究.
科学领域:
- 儿科内分泌学 儿科内分泌学
- 生殖医学 生殖医学
- 增长障碍 发展障碍 发展障碍
背景情况:
- 中部早期青春期 (CPP) 可以对成年人身高产生负面影响.
- 目前的治疗策略,包括淋巴激素释放激素类似物 (GnRHa) 单疗法和组合疗法,表现出不一致的疗效.
- 需要对证据进行全面综合分析,以指导最佳治疗决策.
研究的目的:
- 为了比较GnRHa单一治疗与组合治疗对CPP儿童身高相关结局的影响.
- 综合来自随机对照试验 (RCT) 和队列研究的证据.
- 为了确定影响治疗疗效的因素.
主要方法:
- 系统性审查和RCT和队列研究的元分析.
- 搜索的主要数据库 (PubMed,EMBASE,Cochrane图书馆,万芳,CNKI) 截至2024年12月31日.
- 采用常见或随机效应模型计算平均差异 (MDs) 的数据与95%的置信区间 (CI) 计算身高增长,预测成年人身高 (PAH) 变化和生长速度 (GV).
主要成果:
- 包括70项涉及5,266名儿童的研究.
- 与GnRHa单一治疗相比,生长激素 (GH) 联合治疗显著改善了RCT中的PAH变化和GV,以及队列研究中的身高增长和PAH变化.
- 观察到很高的异质性,限制了确定性;然而,更长的治疗时间和更高的GH剂量与更大的益处有关.
结论:
- 与GnRHa单独治疗相比,GH组合疗法可以提高CPP儿童的生长结果.
- 斯坦诺佐洛尔,牛类和雌激素显示出潜力,但需要进一步调查.
- 个性化组合疗法和额外的长期随机试验,特别是男性患者和非GH疗法,是有必要的.
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