重组人生长激素替代治疗对矮身材儿童非对称性二甲基精氨酸水平的影响

The effect of recombinant human growth hormone replacement therapy on the level of asymmetric dimethylarginine in short stature children

目的分析矮身材儿童重组人生长激素(rhGH)治疗前后血清非对称性二甲基精氨酸(ADMA)水平变化。方法选取生长激素缺乏症(GHD)或特发性身材矮小(ISS)的矮身材儿童63例,健康对照儿童27例为研究对象。观察矮身材儿童治疗前ADMA水平,身高标准差积分(HtSDS)、血脂、葡萄糖代谢参数、动脉硬化指数(Ai)、胰岛素抵抗指数(HOMA-IR)、定量胰岛素敏感性检测指数(QUICKI)等指标变化,并与rhGH治疗6个月和12个月以及健康儿童进行比较。结果GHD组30例、ISS组33例、对照组27例。治疗前GHD组LDL-C、ADMA高于对照组;GHD组、ISS组的Ai水平均高于对照组,而IGF-1水平均低于对照组,差异有统计学意义(P<0.05)。rhGH治疗6个月和12个月后,GHD和ISS患儿的HtSDS均较治疗前升高,IGF-1水平均高于治疗前,差异有统计学意义(P<0.05)。GHD患儿rhGH治疗12个月的TG水平低于治疗前及治疗6个月,治疗12个月血浆ADMA水平低于治疗前;ISS患儿治疗12个月的ADMA水平均低于治疗前和治疗6个月,差异均有统计学意义(P<0.05)。结论GHD患儿ADMA水平明显高于健康儿童,提示矮身材儿童尤其GHD患儿动脉硬化性心血管疾病的发生风险增加。rhGH替代治疗12个月可有效降低矮身材儿童ADMA水平、改善血脂谱,可能在一定程度上减轻动脉硬化性心血管疾病发生风险。

Objective To analyze the changes of serum asymmetric dimethylarginine(ADMA)levels before and after recombinant human growth hormone(rhGH)treatment in short stature children.Methods A total of 63 short children with growth hormone deficiency(GHD)or idiopathic short stature(ISS)and 27 healthy controls were selected as subjects.The ADMA level,height standard deviation score(HtSDS),blood lipid,glucose metabolism parameters,atherogenic index(Ai),homeostatic model assessment for insulin resistance index(HOMA-IR),quantitative insulin sensitivity check index(QUICKI)and other indexes before treatment were observed.They were compared with the indexes 6 and 12 months after rhGH treatment as well as those of healthy children.Results There were 30 children in GHD group,33 children in ISS group and 27 children in control group.Before treatment,The LDL-C and ADMA levels in GHD group were significantly higher than those in control group(P<0.05).The level of Ai in GHD and ISS groups was higher than that in control group,while the level of IGF-1 was lower than that in control group,the differences were statistically significant(P<0.05).After 6 and 12 months of rhGH treatment,the levels of HtSDS and IGF-1 in children with GHD and ISS were higher than those before treatment,and the differences were statistically significant(P<0.05).In children with GHD,the TG level of 12 months after rhGH treatment was significantly lower than that before and 6 months after treatment,and the plasma ADMA level of 12 months after treatment was significantly lower than that before treatment(P<0.05).The ADMA level of ISS children 12 months after treatment was lower than that before and 6 months after treatment,and the differences were statistically significant(P<0.05).Conclusions The level of ADMA in children with GHD is significantly higher than that in healthy children,suggesting that the risk of atherosclerotic cardiovascular disease is increased in children with short stature,especially in children with GHD.The rhGH replacement therapy for 12 months can effectively reduce ADMA level and improve lipid profile in short stature children,which may reduce the risk of atherosclerotic cardiovascular disease to a certain extent.