rhGH治疗青春期特发性矮身材儿童的疗效观察
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摘要
目的观察重组人生长激素(rhGH)对青春期早期儿童特发性矮身材(ISS)的临床疗效。方法将2014年12月至2016年12月期间就诊于保定市第一中心医院确诊为ISS的青春期早期患儿纳入随访,给予饮食、运动、睡眠等合理指导,定期随访,完成12个月随访病例33例。根据治疗与否分为治疗组(16例)和对照组(17例)。收集入组儿童随访开始时的年龄、性别、身高、骨龄、胰岛素样生长因子(IGF)-Ⅰ、性激素等基本信息,及ISS患儿父母的身高情况。计算患儿身高标准差分值、遗传靶身高及治疗12个月后的生长速率。结果两组骨龄差值(△BA 0.94±0.43vs.1.01±0.37)比较差异无统计学意义(P>0.05);随访1年中,两组IGF-Ⅰ呈持续增高趋势,rhGH治疗组较未治疗组偏高。两组患儿生长速率均逐渐增加,至随访结束,两组身高标准差分值(HtSDS)比较差异无统计学意义(P>0.05),但对照组患儿身高平均增加(0.18±0.14)SD,治疗组患儿身高平均增加(0.38±0.09)SD,相比治疗前,两组△HtSDS差异有统计学意义(t=4.67,P<0.05)。结论 rhGH可促进青春期早期ISS患儿生长速率增加,短期内对骨龄无影响,可使终身高增加,但获益有限。
Objective To evaluate the effect of recombinant human growth hormone(rhGH)on early stage of puberty children with idiopathic short stature(ISS).Methods During December 2014 to December 2016,the study included children who diagnosed with ISS in early puberty for follow-up,and they were given diet,exercise and sleep guidance.There were 33 children followed up for 12 months.According to being treated or not treated,the children were divided into treatment group(n=16)and control group(n=17).The data of recruited children including age,sex,height,bone age(BA),insulin-like growth factor-I(IGF-I)and sex hormone were collected,and the height of parents of children with ISS were collected.Height standard deviation score(HtSDS),target height(TH)and growth velocity(GV)after treatment for 12 months were calculated.Results The difference in bone age(△BA0.94±0.43 vs 1.01±0.37)was not statistically significant between two groups(P>0.05).During 1-year follow-up,the serum IGF-I levels in these children showed a trend of increasing,and they were higher in rhGH group than in the control group.The GV of two groups gradually increased,and there was no statistically significant difference in HtSDS between two groups at the end of follow-up(P>0.05).But in the control group,the average height increased(0.18±0.14)SD,and in the treatment group the average height increased(0.38±0.09)SD.The difference was statistically significant when compared to △HtSDS before treatment(t=4.67,P<0.05).Conclusion The rhGH therapy can promote the GV of children with ISS at early puberty.It has no effect on BA in short term but can help to improve final height.
Objective To evaluate the effect of recombinant human growth hormone(rhGH)on early stage of puberty children with idiopathic short stature(ISS).Methods During December 2014 to December 2016,the study included children who diagnosed with ISS in early puberty for follow-up,and they were given diet,exercise and sleep guidance.There were 33 children followed up for 12 months.According to being treated or not treated,the children were divided into treatment group(n=16)and control group(n=17).The data of recruited children including age,sex,height,bone age(BA),insulin-like growth factor-I(IGF-I)and sex hormone were collected,and the height of parents of children with ISS were collected.Height standard deviation score(HtSDS),target height(TH)and growth velocity(GV)after treatment for 12 months were calculated.Results The difference in bone age(△BA0.94±0.43 vs 1.01±0.37)was not statistically significant between two groups(P>0.05).During 1-year follow-up,the serum IGF-I levels in these children showed a trend of increasing,and they were higher in rhGH group than in the control group.The GV of two groups gradually increased,and there was no statistically significant difference in HtSDS between two groups at the end of follow-up(P>0.05).But in the control group,the average height increased(0.18±0.14)SD,and in the treatment group the average height increased(0.38±0.09)SD.The difference was statistically significant when compared to △HtSDS before treatment(t=4.67,P<0.05).Conclusion The rhGH therapy can promote the GV of children with ISS at early puberty.It has no effect on BA in short term but can help to improve final height.
引文
[1]中华医学会儿科学分会内分泌遗传代谢学组,《中华儿科杂志》编辑委员会.基因重组人生长激素儿科临床规范应用的建议[J].中华儿科杂志,2013,51(6):426-432.
[2]颜纯,王慕逖.小儿内分泌学[M].北京:人民卫生出版社,2006:78-79,91-132.
[3]吴迪,冯国双,巩纯秀.生长激素治疗特发性矮小儿童随访至接近成年终身高的治疗效果分析[J].首都医科大学学报,2018,(1):92-97.
[4]Cohen L E.Idiopathic short stature:a clinical review[J].JAMA,2014,311(17):1787-1796.
[5]Ashraf Soliman,Vincenzo De Sanctis,Rania Elalaily,et al.Advances in pubertal growth and factors influencing it:can we increase pubertal growth?[J].Indian J Endocrinol Metab,2014,18(Suppl 1):S53-S62.
[6]Rothenbuhler A,Ormières B,Kalifa G,et al.A pilot study of growth hormone administration in boys with predicted adult short stature and near-endinggrowth[J].Growth Horm IGF Res,2015,25(2):96-102.
[7]Carel J C,Chatelain P,Rochiccioli P,et al.Improvement in adult height after growth hormone treatment in adolescents with short stature born small for gestational age:results of a randomized controlled study[J].J Clin Endocrinol Metab,2003,88:1587-1593.
[2]颜纯,王慕逖.小儿内分泌学[M].北京:人民卫生出版社,2006:78-79,91-132.
[3]吴迪,冯国双,巩纯秀.生长激素治疗特发性矮小儿童随访至接近成年终身高的治疗效果分析[J].首都医科大学学报,2018,(1):92-97.
[4]Cohen L E.Idiopathic short stature:a clinical review[J].JAMA,2014,311(17):1787-1796.
[5]Ashraf Soliman,Vincenzo De Sanctis,Rania Elalaily,et al.Advances in pubertal growth and factors influencing it:can we increase pubertal growth?[J].Indian J Endocrinol Metab,2014,18(Suppl 1):S53-S62.
[6]Rothenbuhler A,Ormières B,Kalifa G,et al.A pilot study of growth hormone administration in boys with predicted adult short stature and near-endinggrowth[J].Growth Horm IGF Res,2015,25(2):96-102.
[7]Carel J C,Chatelain P,Rochiccioli P,et al.Improvement in adult height after growth hormone treatment in adolescents with short stature born small for gestational age:results of a randomized controlled study[J].J Clin Endocrinol Metab,2003,88:1587-1593.
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