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J Zhejiang Univ (Med Sci)
    
Reconsideration of the third-generation non-steroidal aromatase inhibitors in clinical pediatrics
WANG Chunlin, LIANG Li
Department of Pediatrics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Abstract  Aromatase is the rate-limiting enzyme in estrogen biosynthesis. The third generation aromatase inhibitors (AIs), represented by letrozoleand and anastrozole, can combine with aromatase, effectively reducing the estrogen level in the body. Because of its high efficiency, selectivity and reversibility, it has been used in the treatment of McCune-Albright syndrome, familial male-limited precocious puberty, gynecomastia, and adolescent boy with short stature. The good efficacy and safety of AIs have been observed. However, so far the drug instructions of AIs usually do not show indications for children; there are risks of adverse reactions involving liver and kidney function, lipid metabolism, hyperandrogenemia and bone metabolism; especially the long-term effects on reproductive system and bone metabolism are still not clear. Therefore, it is necessary to prescribe it carefully and follow up closely. It was not recommended that AIs be routinely used to improve adult height of adolescent boy with short stature. And more clinical evidences are needed for the safety and effectiveness of AIs prescribed in pediatrics.

Key wordsAromatase inhibitors      Child      Short stature      Off-label     
Received: 29 November 2019      Published: 29 May 2020
CLC:  R588  
  R725.8  
Cite this article:

WANG Chunlin, LIANG Li. Reconsideration of the third-generation non-steroidal aromatase inhibitors in clinical pediatrics. J Zhejiang Univ (Med Sci), 0, 0(0): 1-0.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2020.04.01     OR     http://www.zjujournals.com/med/Y0/V0/I0/1


第三代非甾体类芳香化酶抑制剂在儿科内分泌临床应用的再认识

芳香化酶是雌激素生物合成的限速酶,以来曲唑和阿那曲唑为代表的第三代非甾体类芳香化酶抑制剂(AI)与芳香化酶结合,可有效降低雌激素水平,因其具有高效性、选择性及可逆性结合的特点,近20年来在国内外被应用于儿童内分泌疾病如纤维性骨营养不良综合征、家族性男性限制性性早熟、青春期男性乳房发育和改善青春期矮小男童成年终身高等的治疗,观察到较好的疗效和安全性。然而,AI说明书没有儿童用药适应证,较大样本量的临床研究发现AI存在肝肾功能、脂代谢、高雄激素血症及骨代谢等药物不良反应的风险,尤其是对男性生殖系统和骨代谢的远期影响尚不清楚。因此,儿童青少年使用AI时需权衡利弊、谨慎使用,继续收集AI安全性和有效性的临床证据、积累经验,为规范AI在儿科的临床应用奠定基础。

关键词: 芳香化酶抑制剂,  儿童,  身材矮小症,  超药物说明书 
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