长效生长激素金赛增与短效生长激素赛增治疗生长激素缺乏症的对比研究
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摘要
目的探讨不同时效生长激素对生长激素缺乏症病例的疗效。方法回顾性研究2016～2018年于上海第十人民医院就诊的238例生长激素缺乏症(GHD)患儿,其中38例完全GHD和74例部分GHD患儿给予每周0. 2 mg/kg长效生长激素金赛增治疗(金赛增组);另40例完全GHD和86例部分GHD患儿给予每天0. 067 mg/kg短效生长激素赛增治疗(赛增组),疗程均是3个月。比较金赛增组与赛增组患儿治疗前后身高、年生长速率、血清IGF-1及IGFBP3水平;完全GHD与部分GHD患儿治疗前后身高、年生长速率、血清IGF-1及IGF-BP3水平;金赛增组与赛增组患儿治疗前后甲状腺功能和空腹血糖水平。结果治疗3个月后,金赛增组身高由119±18. 47 cm增至125±14. 56 cm,生长速率由<4 cm/年增至11. 73±4. 66 cm/年,赛增组身高由117±12. 99 cm增至121±8. 71 cm,生长速率由<4 cm/年增至8. 41±3. 54 cm/年;金赛增治疗组血清IGF-1和IGF-BP3水平分别由479. 25±47. 71 ng/ml和8. 37±2. 55μg/ml升至627. 30±91. 34 ng/ml和10. 54±3. 31μg/ml,赛增组血清IGF-1和IGF-BP3水平分别由478. 66±5. 21ng/ml和8. 44±3. 26μg/ml升至584. 28±55. 33 ng/ml和9. 87±2. 68μg/ml;金赛增组对完全GHD和部分GHD患儿的疗效均比赛增组疗效显著(P <0. 05)。但这两种生长激素对不同类型的GHD无靶向优势。两组治疗组3个月甲状腺功能和空腹血糖水平与治疗前比较,均无显著差异(P> 0. 05)。结论长效生长激素与短效生长激素相比,治疗GHD效果更佳,两者在短期疗效内均无副作用。
Objective To explorte the therapeutic effect of growth hormone( GH) with different timeliness for growth hromone deficient( GHD) patients. Methods The clinical data of 238 GHD pediatric patients treated in this hospital during 2016 to 2018 were retrospectively reviewed and compared. Among them,38 cases with complete and 74 with partially growth hormone deficiency were treated with 0. 2 mg/kg/week long-term GH therapy,while other 40 with complete and 86 with partial growth hormone deficiency were treated with 0. 067 mg/kg/d short-term GH both for 3 months. The height,annual growth rate,serum levels of IGF-1 and IGF-BP3 were compared between Jinsaizheng group and Saizheng group before and after treatment; the height,annual growth rate,serum levels of IGF-1 and IGF-BP3 were compared between complete GHD and partial GHD groups before and after treatment; the thyroid function and fasting blood glucose level were compared between Jinsaizheng group and Saizheng group before and after treatment. Results The mean height increase from 119 ± 18. 47 cm to 125 ± 14. 56 cm in long-term GH group while 117 ± 12. 99 cm to 121 ± 8. 71 cm in short-term GH group. And the growth rate increased to 11. 73 ± 4. 66 cm/year in long-term GH group,while 8. 41 ± 3. 54 cm/year in short-term GH group. The serum level of IGF-1 increased from 479. 25 ± 47. 71 ng/ml to627. 30 ± 91. 34 ng/ml in long-term GH group and 478. 66 ± 5. 21 ng/ml to 584. 28 ± 55. 33 ng/ml in short-term GH group while IGF-BP3 increased from 8. 37 ± 2. 55 μg/ml to 10. 54 ± 3. 31 μg/ml in long-term GH group and 8. 44 ± 3. 26 μg/ml to 9. 87 ± 2. 68 μg/ml in short-term GH group. The therapeutic effect of long-term GH group is better than short-term GH group both in complete and incomplete GHD patients( P <0. 05). But neither of these two GHs displayed the target advantage for either complete or incomplete GHD children. Furthermore,neither the thyroid function nor fasting blood glucose level in these two groups were found significant difference before and after treatment. Conclusion Long-term administration of GH has better therapeutic effect than short-term one. Both of these two types of GH administration have no obvious side effect in short term treatment.
Objective To explorte the therapeutic effect of growth hormone( GH) with different timeliness for growth hromone deficient( GHD) patients. Methods The clinical data of 238 GHD pediatric patients treated in this hospital during 2016 to 2018 were retrospectively reviewed and compared. Among them,38 cases with complete and 74 with partially growth hormone deficiency were treated with 0. 2 mg/kg/week long-term GH therapy,while other 40 with complete and 86 with partial growth hormone deficiency were treated with 0. 067 mg/kg/d short-term GH both for 3 months. The height,annual growth rate,serum levels of IGF-1 and IGF-BP3 were compared between Jinsaizheng group and Saizheng group before and after treatment; the height,annual growth rate,serum levels of IGF-1 and IGF-BP3 were compared between complete GHD and partial GHD groups before and after treatment; the thyroid function and fasting blood glucose level were compared between Jinsaizheng group and Saizheng group before and after treatment. Results The mean height increase from 119 ± 18. 47 cm to 125 ± 14. 56 cm in long-term GH group while 117 ± 12. 99 cm to 121 ± 8. 71 cm in short-term GH group. And the growth rate increased to 11. 73 ± 4. 66 cm/year in long-term GH group,while 8. 41 ± 3. 54 cm/year in short-term GH group. The serum level of IGF-1 increased from 479. 25 ± 47. 71 ng/ml to627. 30 ± 91. 34 ng/ml in long-term GH group and 478. 66 ± 5. 21 ng/ml to 584. 28 ± 55. 33 ng/ml in short-term GH group while IGF-BP3 increased from 8. 37 ± 2. 55 μg/ml to 10. 54 ± 3. 31 μg/ml in long-term GH group and 8. 44 ± 3. 26 μg/ml to 9. 87 ± 2. 68 μg/ml in short-term GH group. The therapeutic effect of long-term GH group is better than short-term GH group both in complete and incomplete GHD patients( P <0. 05). But neither of these two GHs displayed the target advantage for either complete or incomplete GHD children. Furthermore,neither the thyroid function nor fasting blood glucose level in these two groups were found significant difference before and after treatment. Conclusion Long-term administration of GH has better therapeutic effect than short-term one. Both of these two types of GH administration have no obvious side effect in short term treatment.
引文
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[9]Chen S,You H,Pan H,et al.The effects of genetic polymorphism on treatment response of recombinant human growth hormone[J].Current Drug Metabolism,2017,19.
[10]仝月菊,付正卿,梁红丽,等.重组人生长激素剂型改造及给药途径的研究进展[J].中国临床药学杂志,2015,(5):330-335.
[11]于宝生,李述庭,张永泉,等.重组人生长激素治疗生长激素缺乏症疗效观察[J].中华实用儿科临床杂志,2003,18(8):598-600.
[12]侯凌,罗小平,杜敏联,等.重组人生长激素注射液治疗儿童生长激素缺乏症的临床评价[J].中华儿科杂志,2009,47(1):48-52.
[2]赵强,李志洁.重组人生长激素治疗儿童生长激素缺乏症和特发性矮小症45例疗效观察[J].中国妇幼保健,2016,31(6):1300-1302.
[3]赵诸慧,奚立,程若倩,等.生长激素治疗生长激素缺乏症儿童对骨代谢的影响及其相关性研究[J].临床和实验医学杂志,2016,15(22):2246-2249.
[4]Kim SJ,Kim CW.Characterization of recombinant human growth hormone variants from sodium hyaluronate-based sustained release formulation of rh GH under heat stress[J].Anal Biochem,2015,485:59-65.
[5]Yang H,Wang L,Qiu X,et al.Body composition and metabolic health of young male adults with childhood-onset multiple pituitary hormone deficiency after cessation of growth hormone treatment[J].J Pediatr Endocrinol Metab,2018,31(5):533-537.
[6]Cutfield W S,Derraik J G,Gunn A J,et al.Non-Compliance with Growth Hormone Treatment in Children Is Common and Impairs Linear Growth[J].Plos One,2011,6(1):e16223.
[7]Lundberg E,Andersson B,Kristr9m B,et al.Broad variability in pharmacokinetics of GH following rhGH injections in children.[J].Growth Horm IGF Res,2018,40:61-68.
[8]唐姝,陈志祥,陆伟根.重组人生长激素长效制剂的研究进展[J].世界临床药物,2014,35(1):36-41.
[9]Chen S,You H,Pan H,et al.The effects of genetic polymorphism on treatment response of recombinant human growth hormone[J].Current Drug Metabolism,2017,19.
[10]仝月菊,付正卿,梁红丽,等.重组人生长激素剂型改造及给药途径的研究进展[J].中国临床药学杂志,2015,(5):330-335.
[11]于宝生,李述庭,张永泉,等.重组人生长激素治疗生长激素缺乏症疗效观察[J].中华实用儿科临床杂志,2003,18(8):598-600.
[12]侯凌,罗小平,杜敏联,等.重组人生长激素注射液治疗儿童生长激素缺乏症的临床评价[J].中华儿科杂志,2009,47(1):48-52.