重组人生长激素治疗对特发性矮小儿童的糖脂代谢及甲状腺功能的影响

Effects of r-h GH replacement therapy on glucose and lipid metabolism and thyroid function in children with idiopathic short stature

目的探讨重组人生长激素（r-h GH）对特发性矮小（ISS）儿童的糖、脂代谢及甲状腺功能的影响。方法选取2009年1月至2013年1月应用r-h GH治疗并定期随访的ISS儿童47例,年龄为10±3岁,治疗期限为3~24个月,随访间隔为每3个月1次,检测治疗后0~1年及治疗后1~2年时的空腹血糖、胰岛素、血脂、甲状腺功能等指标的变化。结果 r-h GH治疗后,患儿空腹血糖、胰岛素水平、胰岛素敏感指数、空腹血糖/胰岛素比值（FGIR）与治疗前比较差异无统计学意义,但FGIR有下降趋势;FGIR〈7（提示胰岛素抵抗）的患儿治疗前为13%（6/47）,治疗后1~2年为18%（4/22）。治疗后动脉粥样硬化指数较前下降,而总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白水平及BMI与治疗前比较差异无统计学意义。治疗前后甲状腺功能无明显变化。结论 r-h GH治疗ISS儿童是安全可靠的,可改善脂代谢,对甲状腺功能、空腹血糖、胰岛素水平无明显影响,但有胰岛素敏感性降低的可能。

Objective To study the effects of recombinant human growth hormone （r-hGH） replacement therapy on glucose and lipid metabolism and thyroid function in children with idiopathic short stature （ISS）. Methods Forty- seven ISS children with a mean age of 10±3 years treated between January 2009 and January 2013 were enrolled. All children underwent r-hGH replacement therapy for 3-24 months and were followed up once every 3 months. Fasting blood glucose （FBG）, insulin （INS）, blood lipids and thyroid function were measured before treatment and after 0-1 and 1-2 years of treatment. Results After treatment with r-hGH, there were no significant changes in FBG, INS, insulin sensitivity index （ISI）, and FBG/INS ratio （FGIR）, but the FGIR showed a declining trend. The percentage of patients with FGIR〈7 （a marker of insulin resistance） was 13% before treatment compared to 18% 1-2 years after treatment. The atherosclerosis index decreased after r-hGH treatment, but there were no significant changes in total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and BMI. Furthermore, no significant change in thyroid function was observed after r-hGH therapy. Conclusions r-hGH therapy can improve lipid metabolism, without significant impacts on thyroid function, FBG and INS. It seems to be a safe and reliable therapy for children with ISS. However, this therapy possibly reduces insulin sensitivity.