生长激素缺乏症患儿重组人生长激素治疗前、后肾上腺皮质功能的变化

Changes of adrenal cortical function in children with growth hormone deficiency before and after treatment with recombinant human growth hormone

目的观察生长激素缺乏症(GHD)患儿重组人生长激素(rh GH)治疗前、后肾上腺皮质功能的变化。方法选取72例确诊GHD并接受rh GH治疗6个月以上的患儿,其中32例伴促肾上腺皮质激素(ACTH)缺乏,回顾性分析其在接受rh GH治疗前及治疗后3、6个月时清晨空腹血皮质醇(COR)、ACTH水平的变化。结果 32例伴ACTH缺乏患儿通过外源性补充氢化可的松(HC)使COR达正常水平后,再开始rh GH治疗,治疗前COR水平和使COR达正常下限时的HC剂量呈显著负相关(r=-0.899,P<0.01)。单纯HC治疗1个月后COR水平较治疗前明显增高,ACTH水平明显下降,差异均有统计学意义(P<0.001);经rh GH和HC替代治疗后3、6个月后COR及ACTH水平与单纯HC治疗1个月差异无统计学意义(P>0.05)。40例无ACTH缺乏患儿在rh GH治疗后COR水平显著降低,与治疗前比较差异有统计学意义(P<0.01),其中10例MRI显示下丘脑-垂体异常患儿表现为COR水平低下。结论 GHD患儿在rh GH治疗过程中可出现肾上腺皮质功能减低,特别是MRI显示垂体异常的患儿,应注意监测肾上腺皮质功能,及早干预。

Objective To observe the changes of adrenal cortical function in children with growth hormone deficiency before and after treatment with recombinant human growth hormone. Methods Seventy-two children diagnosed with GHD who received rhGH treatment for no less than 6 month were included, among whom there were 32 children who were accompanied with adrenal cortical hormone (ACTH) deficiency. The changes of fasting plasma cortisol (COR) and ACTH levels before and3 and 6 months after treatment with rhGH were retrospectively analyzed. Results Thirty-two children with ACTH deficiencywere treated with rhGH after COR level reached normal by the supplementing exogenous hydrocortisone. There was negative correlation between COR level before treatment and the HC dose that make the COR reach normal lowest limit level (r = -0.899,P < 0.01). One month after HC treatment only, the level of COR was obviously increased and ACTH was obviously decreased (Pall < 0.001). The levels of COR or ACTH at 3 or 6 months after rhGH and HC replacement therapy were not different from thoseat one month after HC treatment only (P all > 0.05). The level of COR was obviously decreased after treatment with rhGH, andthere was statistical difference compared with that before treatment (P < 0 . 01 ) in 40 children without ACTH deficiency, amongwhom 10 children with abnormal hypothalamic pituitary MRI had lower level of COR. Conclusion Adrenal cortical function canbe reduced during the treatment with rhGH in children with GHD, especially in children with abnormal hypophysis MRI. Thus,during the treatment period, adrenal cortical function should be monitored, so as to make early intervention.