生长激素疗法对特纳综合征患者生长发育指标的影响分析

Effects of growth hormone therapy on growth indexes in children with Turner syndrome

目的研究生长激素(hGH)疗法对特纳综合征患者标准差(HtSD)增长、体质量指数(BMI)及生长因子水平的影响。方法选择2009年5月至2014年5月,在广东省中山市博爱医院接受治疗的78例特纳综合征患者作为研究对象。比较经GH治疗前后,特纳综合征患儿HtSD增长、BMI及生长因子水平。结果应用GH治疗后生长速率(GV)及HtSD指数均显著高于应用GH治疗前;应用GH治疗后BMI指数均显著高于应用GH治疗前,差异均有统计学意义(t值分别为23.442、7.434、4.917,均P<0.05)。应用GH治疗后胰岛素样生长因子-1(IGF-1)及胰岛素样生长因子结合蛋白-3(IGFBP-3)水平均显著高于应用GH治疗前(t值分别为10.308、6.794,均P<0.05),但骨龄在治疗前后差异无统计学意义(t=1.578,P>0.05)。应用GH治疗后患儿身高及体重均显著高于应用GH治疗前,差异均有统计学意义(t值分别为4.231、4.511,均P<0.05);治疗中5例血清谷丙转氨酶有出现超标的现象,经停药观察,全部恢复正常水平,治疗中2例患者还有过敏性皮疹等表现,均未采取特殊处理,其自行消除;部分患者在治疗中有下肢疼痛现象,补充钙剂后,疼痛消除。结论生长激素疗法不仅能有效调控特纳综合征患者的生长因子IGF-1及IGFBP-3水平,还能促使HtSD增长,对身高与体重增加、改善BMI指数等方面效果显著,且安全性高。

Objective To study the effect of human growth hormone（hGH）therapy on standard deviation（HtSD）growth,body weight index（BMI）and growth factor level in children with Turner syndrome.Methods A total of 78 children with Turner syndrome treated in Boai Hospital of Zhongshan from May 2009 to May 2014 were selected as study objects.HtSD growth,BMI and growth factor level in children with Turner syndrome before and after GH therapy were compared.Results Growth velocity（GV）and HtSD indexes after GH treatment were significantly higher than those before GH treatment,and BMI index after GH treatment was significantly higher than that before GH treatment with significant differences（t value was 23.442,7.434 and4.917,respectively,all P0.05）.Insulin-like growth factor-1（IGF-1）and insulin-like growth factor binding protein-3（IGFBP-3）levels after GH treatment were significantly higher than those before GH treatment（t value was 10.308 and 6.794,respectively,both P0.05）.Bone age had no statistically significant difference before and after treatment（t=1.578,P0.05）.Weight and height of children after GH treatment were significantly suerior than those before GH treatment and differences were statistically significant（t value was 4.231 and 4.511,respectively,both P0.05）.During treatment,there were 5 cases with exceeding level of serum alanine aminotransferase,but all returned to normal after drug withdrawal.Two cases had allergic skin rash,which eliminated by itself without special treatment.Some children had lower limb pain during treatment,and pain was eliminated after calcium supplementation.Conclusion Growth hormone therapy can not only effectively regulate and control IGF-1 and IGFBP-3 in children with Turner syndrome,but obtain significant effects in promoting HtSD growth and increase of height and weight as well as improving BMI with high safety.