维生素D辅助重组人生长激素治疗儿童生长激素缺乏症对儿童生长及骨代谢的影响

Effect of vitamin D combined with recombinant human growth hormone on growth factor and bone metabolism in children with growth hormone deficiency

目的分析维生素D辅助重组人生长激素(rhGH)治疗儿童生长激素缺乏症(GHD)对儿童生长及骨代谢的影响。方法选择80例GHD患儿分为观察组和对照组,每组各40例,对照组患儿接受饮食指导及rhGH等常规治疗,观察组在对照组的基础上服用维生素D钙咀嚼片。比较2组患儿在治疗前和治疗6个月后(治疗后)的体格相关指标[身高标准差分值(HtSDS)、每年增长幅度、体质量、骨龄]、生长因子[胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)]、骨代谢指标[骨钙素、Ⅰ型胶元羧基末端肽(ICTP)、骨碱性磷酸酶(BAP)]、甲状腺功能[T3、甲状腺素(T4)、TSH]、肾上腺皮质功能[促肾上腺皮质激素(ACTH)、皮质醇]以及Achenbach儿童行为量表(CBCL)评分。结果治疗后2组患儿的体格相关指标、生长因子、骨代谢指标均比治疗前改善,皮质醇、ACTH、CBCL评分均比治疗前降低,T3、T4、TSH均比治疗前升高(P均<0.05)。与对照组治疗后比较,观察组治疗后的HtSDS、每年增长幅度、IGF-1、IGFBP-3、骨钙素、ICTP、BAP较高,CBCL评分较低(P均<0.05)。治疗后2组患儿的甲状腺和肾上腺皮质功能指标比较差异均无统计学意义(P均>0.05)。用药期间2组患儿的甲状腺功能异常、膝部疼痛发生率比较差异均无统计学意义(P均>0.05);观察组注射处水肿、男性乳房发育发生率均低于对照组(P均<0.05)。结论维生素D辅助重组人生长激素治疗儿童GHD效果较好,且安全性高。

Objective To evaluate the effect of vitamin D combined with recombinant human growth hormone(rhGH)on growth factors and bone metabolism in children with growth hormone deficiency(GHD).Methods Eighty children with GHD were divided into the observation(n=40)and control groups(n=40).Routine treatments including dietary guidance and rhGH therapy were given in the control group.In the observation group,vitamin D was supplemented on the basis of routine treatments.Before and 6 months after treatment,physical parameters such as height standard deviation score(HtSDS),growth velocity(GV),body mass and bone age,growth factors such as insulin-like growth factor-1(IGF-1),insulin-like growth factor binding protein-3(IGFBP-3),bone metabolism parameters such as osteocalcin,carboxy-terminal telopeptide of type I collagen(ICTP)and bone alkaline phosphate(BAP),thyroid function such as T3,thyroxine(T4)and TSH,adreno-cortico-tropic-hormone(ACTH,cortisol)and Achenbach Child Behavior Checklist(CBCL)score were statistically compared between two groups.Results After corresponding treatments,physical parameters,growth factors and bone metabolism parameters were significantly improved,the cortisol,ACTH and CBCL score were remarkably decreased,whereas the T3,T4 and TSH levels were considerably elevated in two groups(all P<0.05).Following treatments,HtSDS,GV,IGF-1,IGFBP-3,osteocalcin,ICTP and BAP in the observation group were significantly higher than those in the control group(all P<0.05).The throid and ACTH parameters did not significantly differ between two groups after corresponding treatments(all P>0.05).The incidence of thyroid dysfucntion and knee pain did not significantly differ between two groups throughout the drug administration(both P>0.05).In the observation group,the incidence of edema at the injection site and breast development in male was significantly lower than that in the control group(both P<0.05).Conclusion Vitamin D combined with rhGH is an efficacious and safe treatment of GHD in children.