重组人生长激素治疗骨龄13～17岁的特发性生长激素缺乏性矮小症

Application of recombinant human growth hormone in idiopathic growth hormone deficient children with bone ages between 13 and 17 years

目的探讨重组人生长激素(rhGH)对骨龄13～17岁的特发性生长激素缺乏性(IGHD)矮小症患者的促身高增长疗效.方法 21例骨龄13～17岁的IGHD 患者被分为两组,A组(骨龄13.0～14.9岁)和B组(骨龄15.0～17.0岁).A组11例(男8,女3),B组10例(男6,女4),年龄分别为(17.9±3.2)岁,(18.7±2.1)岁;骨龄分别为(13.5±0.6)岁,(15.2±0.4)岁,其身高标准差计分分别为-4.6±1.6,-3.3±0.8,而治疗前生长速度分别为(2.6±1.1)和(2.3±0.9)cm /年.每晚睡前皮下注射 rhGH 0.1 IU/kg共6个月.结果 A,B两组IGHD患者的身高分别由治疗前(140.3±9.2)和(147.5±5.3)cm增至(145.5±8.6)和(151.9±5.9)cm,两组患儿治疗1～3个月时的生长速度明显增加,但B组治疗4～6个月时的生长速度明显减缓,并明显低于A组患儿4～6个月时生长速度(P＜0.05);而两组患儿的体重和骨龄均没有明显的变化.在骨龄为15～17岁的IGHD患者中,血清胰岛素样生长因子Ⅰ和骨钙素水平明显升高(均P＜0.05).结论 rhGH治疗对骨龄为13～17岁的IGHD患儿身高的增长仍有促进作用.

Objective To assess the efficacy of recombinant human growth hormone (rhGH) in idiopathic growth hormone deficient (IGHD) children with the bone age (BA) of 13.0-17.0 years. Methods This was a noncomparative prospective study including 21 children who were divided into 2 groups according to their BA. BA of A group was 13.0-14.9 years, BA of B group was 15.0-17.0 years. A group consisted of 11 cases (8 boys and 3 girls), with an average chronological age (CA) (17.9±3.2)years and BA (13.5±0.6)years; B group was composed of 10 cases( 6 boys and 4 girls), with mean CA (18.7±2.1)years and BA (15.2±0.4)years.The body height SDS of A group and B group was -4.6±1.6 and -3.3±0.8 respectively,and the respective growth velocity of A group and B group was (2.6±1.1) and (2.3±0.9)cm /year before treatment.The enrolled children were treated with subcutaneous injection of rhGH (0.1 IU/kg) daily before sleep for six months. Results The mean height of A group and B group increased from (140.3±9.2) and (147.5±5.3)cm to (145.5±8.6) and (151.9±5.9)cm respectively. The growth velocity of A group and B group increased strikingly during 0-3 months,but the growth velocity of B group during 4-6 months decreased, being significantly lower than that of A group during 4-6 months(P<0.05). There were no change in mean body weight and BA during the whole course of rhGH therapy.Serum insulin-like growth factor-Ⅰ and osteocalcin level increased strikingly in IGHD patients of B group after rhGH therapy (all P<0.05). Conclusion rhGH appears to be an effective and safe drug in promoting the growth in IGHD with the BA of13.0-17.0years.