重组人生长激素治疗青春前期生长激素缺乏症患儿第1年生长速度目标探讨

Height velocity targets for the first year in response to recombinant human growth hormone(rh GH)treatment in pre-pubertal Growth Hormone Deficiency(GHD)children

目的分析重组人生长激素(rhGH)治疗生长激素缺乏症(GHD)患儿的第1年生长速度,探讨判断rh GH疗效的理想目标。方法回顾性分析2000年1月至2009年12月于中山大学附属第一医院生长中心诊断的3岁至青春前期GHD患儿资料。按骨龄分段统计生长速度。以未接受rh GH治疗的GHD患儿257例的生长速度(HV_0)作为未治疗对照。接受治疗者再分为2组:GH激发峰值<0.33 nmol/L(7 ng/m L)(GHD-1组),140例;GH激发峰值0.33~0.47 nmol/L(GHD-2组),33例。2组rh GH剂量均为每周0.7 U/kg。分别计算2组治疗1年时的生长速度(HV_1),并进行对比。结果治疗后2组的HV_1均显著高于HV_0,GHD-1组各骨龄段HV_1均显著高于GHD-2组(均P<0.05):骨龄<3岁段为11.0(10.5~11.5)cm/年vs.9.9(9.1~10.8)cm/年;骨龄3~5岁段为10.4(9.8~10.9)cm/年vs.8.8(8.3~9.2)cm/年;骨龄6~10岁段为9.5(9.1~9.9)cm/年vs.8.5(8.0~9.1)cm/年。GHD-2组的HV_1中位数与GHD-1组的第25百分位值(P25)相近。结论推荐青春前期GHD患儿rh GH治疗后第1年的生长速度的理想目标为GHD-1组HV_1的P25,即对<3岁、3~5岁和6~10岁骨龄段分别至少达到9.9 cm/年、8.7 cm/年和8.3 cm/年。

Objective To describe height velocity in pre-pubertal Growth Hormone Deficiency （GHD） children without recombinant human growth hormone （rhGH） treatment and explore the height velocity targets for the first year in response to rhGH treatment. Methods Analyze retrospectively the height velocity data without （HV0） and one year after （HV1） rhGH treatment in physiologic dose [0.7 U/（kg· w）] in pre-pubertal GHD children above 3 years old who were diagnosed from Jan, 2000 to Dec, 2009 in our hospital. The GHD patients who were included for calculation of HV0 had peak GH value in GH provocative test less than 7 ng/ml. HV0 was calculated according to age （HV0-CA, 342 patients） and bone age （HVo-BA, 257 patients） respectively. According to the peak GH value in GH provocative test, the patients who were included for calculation of HVI were divided into GHD-1 group （ 〈 0.33 nmol/L, 140 patients） and GHD-2 group（7.0 ～ 9.9 μg/L, 33 patients）. Results Within every bone age group, GHD-1 group had significantly higher HV1 than GHD-2 group（P〈0.05）, 11.0（10.5-11.5） cm/a（n = 34） vs. 9.9（9.1-10.8） crn/a（n = 6） when bone age was less than 3 years, 10.4 （9.8～10.9 ） cm/a （n = 48 ） vs. 8.8 （ 8.3～ 9.2） cm/a （n = 8 ） when bone age was between 3 to 5 years, and 9.5（9.1～9.9） crn/a（n = 58） vs. 8.5 （8.0～9.1） cm/a（n = 19） when bone age was between 6 to 10 years. The mean HV1 of GHD-2 was very close to the 25th percentile （P25） of GHD-1 group. They both were significantly higher than HV0-BA. Conclusion The recommended height velocity target for the first year after rhGH treatment in prepubertal GHD children is the P25 of HV1 of GHD-1 group. It should be at least 9.9 cm/a, 8.7 cm/a and 8.3 cm/a when the bone age is less than 3 years, 3 to 5 years and 6 to 10 years, respectively.