不同剂量r-hGH对特发性矮小患儿IGF-1和IGFBP-3水平的影响

Different doses of r-hGH on levels of IGF-1 and IGFBP-3 in children with ISS

目的探讨不同剂量重组人生长激素(r-hGH)对治疗特发性矮小(ISS)患儿的血清胰岛素样生长因子-1(IGF-1)和胰岛素样生长因子结合蛋白-3(IGFBP-3)水平的影响,为临床用药剂量提供依据。方法选取2014年8月至2017年3月大兴区妇幼保健院收治的ISS患儿120例,按照治疗意愿分为高剂量组、低剂量组和对照组(各组均n=40),高剂量组为r-hGH 0.18 IU·kg^-1·d^-1,低剂量组为0.12 IU·kg^-1·d^-1,对照组未予以r-hGH治疗。观察比较三组患儿治疗后的身高(Ht)、身高标准差积分(HtSDS)、生长速率(GV)、治疗前后血清IGF-1及IGFBP-3浓度、不良反应情况。结果三组患儿治疗前Ht、HtSDS、GV、IGF-1、IGFBP-3差异均无统计学意义(均P>0.05)。治疗后三组患儿Ht、HtSDS、GV、IGF-1、IGFBP-3差异有统计学意义(F1=4.368,F2=2.110,F3=5.117,F4=2.970,F5=2.238,均P<0.05)。两两比较后发现高剂量组的Ht、HtSDS、GV、IGF-1、IGFBP-3均优于低剂量组,且低剂量组优于对照组。高剂量组和低剂量组患儿的不良反应率比较差异无统计学意义(χ^2=0.556,P>0.05),且均为轻度不良反应可自行缓解。结论高剂量r-hGH可有效提高患儿血清IGF^-1、IGFBP-3的水平,改善ISS患儿病情,安全有效,可在临床推广应用。

Objective To find the effects of different doses of recombinant human growth hormone(rhGH) on serum insulin-like growth factor-1(IGF-1) and insulin-like growth factor binding protein-3(IGFBP-3) levels in children with idiopathic short stature,and to provide evidence for clinical dosage.Methods 120 children with ISS admitted to our hospital during the period from August 2014 to March 2017 were divided into high dose group,low dose group and control group(n=40,respectively) according to their expectation of treatment.The high-dose group was 0.18 IU kg^-1 d^-1,and the low-dose group was 0.12 IU kg^-1 d^-1.The control group was not treated with r-hGH.After the treatment,observation and comparison of the three groups of children in Ht,HtSDS,GV,serum IGF-1,IGFBP-3 concentration before and after the treatment,adverse reactions were analyzed.Results There was no significant difference in Ht,HtSDS,GV,IGF-1 and IGFBP-3 among the three groups before treatment(P>0.05 for all).After the treatment,there were significant differences in Ht,HtSDS,GV,IGF-1 and IGFBP-3 among the three groups(F1=4.368,F2=2.110,F3=5.117,F4=2.970,F5=2.238,respectively,P<0.05 for all).After two comparisons,it was found that indexes of Ht,HtSDS,GV,IGF-1 and IGFBP-3 in the high dose group were better than those in the low dose group,and those in the low dose group were better than those in the control group.There was no significant difference in the rate of adverse reactions between the high dose group and the low dose group(χ^2=0.556,P>0.05),and the mild adverse reactions could be alleviated by themselves.Conclusion High dose r-hGH can effectively improve the serum levels of IGF-1 and IGFBP-3 in children with ISS.It is safe and effective,and can be widely used in clinic.