重组人生长激素联合心理干预治疗特发性矮小症患儿的疗效及机制研究

Effect of rhGH combined with psychological intervention on children with idiopathic short stature and its mechanism

目的研究重组人生长激素(rhGH)联合心理干预治疗特发性矮小症患儿的疗效及机制。方法选取2016年1月—2019年1月天津市第五中心医院收治的90例特发性矮小症患儿,将其随机分为观察组和对照组,每组45例。两组患儿实施相同的常规治疗。在此基础上,对照组患儿行rhGH治疗;观察组患儿行rhGH联合心理干预。在两组患儿治疗干预前后,评价患儿心理及情绪状态,调查rhGH治疗的依从性,检测生长指标[身高、身高标准差积分(Ht SDS)、生长速度(GV)、预测成年身高(PAH)]、骨代谢指标{血清骨钙素(OC)和25羟基维生素D[25(OH)D]}和胰岛素生长因子-1(IGF-1)。结果两组患儿HAMA、情绪稳定性评分在不同时间、不同组间及变化趋势上有差异(P<0.05)。治疗3个月、6个月,两组患儿rhGH治疗依从性比较,差异无统计学意义(P>0.05);但治疗9个月、12个月,观察组rhGH治疗依从性高于对照组(P<0.05)。观察组治疗前后身高、Ht SDS、GV、PAH的差值大于对照组(P<0.05)。观察组治疗前后OC、25(OH)D、IGF-1的差值大于对照组(P<0.05)。结论rhGH联合心理干预能有效提高特发性矮小症患儿的临床疗效,其原因可能与心理干预可有效改善患儿不良心理,提高rhGH治疗依从性及改善骨代谢、IGF-1水平有关。

Objective To observe the therapeutic effect of recombinant human growth hormone(rhGH)combined with psychological intervention on children with idiopathic short stature and to investigate its mechanism.Methods A total of 90 children with idiopathic short stature in our hospital from January 2016 to January 2019 were randomly divided into observation group and control group,with 45 cases in each group.All the children were given conventional therapies,based on which the control group was treated with rhGH alone while the observation group was treated with combined rhGH and psychological intervention.Before and after the treatment,the psychological and emotional states of the two groups of children were evaluated,the rhGH treatment compliance was investigated,and the growth indicators[height,height standard deviation score(Ht SDS),growth velocity(GV),predicted adult height(PAH)],bone metabolic indicators serum osteocalcin(OC),25-hydroxyvitamin D[25(OH)D]and insulin growth factor-1(IGF-1)were detected.Results The scores of Hamilton Anxiety Scale(HAMA)and emotional stability of children differed between the two groups and altered at different time points with distinct change trends(P<0.05).There was no difference in rhGH treatment compliance between the two groups at 3 and 6 months after the treatment(P>0.05).However,at 9 and 12 months following the treatment,rhGH treatment compliance was higher in the observation group(P<0.05).The differences of height,Ht SDS,GV and PAH before and after treatment were greater in the observation group than those in the control group(P<0.05).Besides,the differences of OC,25(OH)D and IGF-1 before and after treatment were also greater in the observation group(P<0.05).Conclusions On the basis of rhGH treatment,combined with psychological intervention can effectively enhance the clinical efficacy of idiopathic short stature in children.The mechanism may be related to the improvement in children’s mental health,rhGH treatment compliance,bone metabolism,and IGF-1 level.