特发性生长激素缺乏性矮小症在重组人生长激素治疗1年后身体构成的变化

Effects of recombinant human growth hormone for body compositions in adolescence with idiopathic growth hormone deficiency

目的:探讨青春期前特发性人生长激素缺乏症(IGHD)用基因重组人生长激素(rhGH)治疗后其身体构成的改变。方法:17例年龄为(14．6±4．5)岁,骨龄(12．1±0．8)岁的IGHD青少年(男14例,女3例),在rhGH治疗前生长速度每年(2．9±0．7)cm,患者每周0．5 u·kg-1,分5次于临睡前皮下注射rhGH,共1年。测定患者治疗前和治疗后1,3,6,9和12个月身高、体重、体内脂肪百分含量(F％)、去脂肪量(FFM)、左右手握力、血胰岛素样生长因子-1(IGF-1)和血胰岛素样生长因子结合蛋白-3(IGFBP-3)水平,并以2002年中国北方177例正常青少年值作为对照。结果:治疗前IGHD患者的身高、体重、FFM及血IGF-1和IGFBP-3水平均显著低于正常青少年(P<0．05),F％明显高于正常青少年(P<0．05),但体重指数(BMI)值无明显差异。用rhGH治疗1个月及随后治疗中,患者F％均显著低于治疗前(P<0．05),与正常青少年无统计学差异。经rhGH治疗6个月,17例IGHD患者的身高、生长速度、FFM及血IGF-1和IGFBP-3水平均明显增加(均P<0．05),其改变值均与F％的下降值相关(P均<0．01)。治疗1年后,所有患者的握力均明显增加。结论:IGHD青少年在使用rhGH后,身高、FFM及握力均显著增加,F％减少,提示患者骨骼和肌内组织的增加及脂肪含量的降低,即身体的构成发生了明显的改变。

Objective ：To assess the effect of recombinant human growth hormone （rhGH） on the body compositions in adolescence with idiopathic growth hormone deficiency （IGHD）. Methods：Seventeen adolescences with IGHD at chronological age of （14.6 ± 4.5） but bone age （BA） of （12. 1 ± 0. 8） were subcutaneously injected with rhGH （0.5 u·kg^-1 ） weekly before sleep for one year. The injection was dosed five times every week. The adolescence had a growth velocity of （2.9 ±0.7） cm/year before therapy. The effect of the treatment was evaluated based on changes of several factors including height, body weight, fat percentage （ F% ）, free fat mass （ FFM）, grips of both hands, serum insulin-like growth factor-1 （IGF-1）and insulin-like growth factor binding protein-3 （IGFBP-3）before and after 1, 3, 6, 9 and 12 months of the therapy. A total of 177 healthy Northen Chinese adolescences at age of 6 ～ 16 was used as normal control. Results： The pretreated adolescences significantly showed less height, weight, FFM, serum IGF-1 and IGFBP-3 and more F% than healthy adolescences （P 〈 0.05）. No statistical difference of body mass index （BMI, kg·m^-2） was found between two adolescence groups. The adolescences that were treated for 1 month significantly decreased fat percentage （P 〈 0.05） and showed no difference from healthy adolescences. After 6-month therapy, the adolescences significantly increased the height, body weight, growth velocity, FFM, serum IGF-1 and IGFBP-3 （P 〈 0. 05） , which were negatively proportioned to the reduction of fat percentage （P 〈 0.01 ）. At the end of therapy, the adolescences showed more powerful grip of both hands compared to pre-treatment. Conclusion：The rhGH offers therapeutic significance on the body compositions in adolescences with IGHD.