rhGH治疗小儿GHD的效果及相关影响因素分析

Efficacy of rhGH in the treatment of CHD in children and related influencing factors

目的探讨重组人生长激素(rhGH)治疗小儿生长激素缺乏症(GHD)的疗效及相关影响因素。方法选择确诊并收治的50例GHD患儿,对患者使用重组人生长激素治疗,探讨治疗效果并观察患者身高(Ht)、体重(Wt)、生长速率(GV)、身高标准差积分(HtSDS)、体重指数(BMI)进行检测和记录,同时统计0~3个月、3~6个月GV、Ht、HtSDS的平均值(ΔGV、ΔHt、ΔHtSDS)。观察治疗前、治疗后3个月、6个月血清学指标[胰岛素样生长因子(IGF-1)、骨碱性磷酸酶(BAP)、C型钠尿肽前体氨基末端肽(NT-proCNP)、骨钙蛋白(OC)、尿酸、空腹血糖(FBG)、血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)]对治疗的影响以及相关影响因素。结果GHD患者治疗后6个月GV、Ht、HtSDS较治疗后3个月、治疗前要明显较高(P<0.05);治疗后3个月GV、Ht、HtSDS较治疗前要明显较高(P<0.05);GHD患者治疗后,其0~3个月的ΔGV、ΔHt、ΔHtSDS明显高于治疗后3~6个月(P<0.05);GHD患者治疗后6个月IGF-1、OC、BAP、尿酸以及NT-proCNP较治疗后3个月、治疗前要明显较高(P<0.05);治疗后3个月IGF-1、OC、BAP、尿酸以及NT-proCNP较治疗前明显长高(P<0.05);治疗后3、6个月血清FT4较治疗前明显降低,且FT3/FT4较治疗前明显升高(P<0.05);治疗后GV3、ΔHt 0~3、ΔHtSDS 0~3及治疗前FT4,与GHD患者GV6呈正相关(P<0.5);而与ΔIGF-10~3及GH峰值呈负相关(P<0.05);治疗后GV3、ΔHt 0~3、ΔHtSDS 0~3与GHD患者ΔHtSDS 0~6呈正相关(P<0.5),而与治疗前CA、BA、WT、Ht、BMI及IGF-1呈负相关(P<0.05);GHD患者GV6影响因素为GV3、ΔIGF-10~3;GHD患者ΔHtSDS 0~6影响因素为治疗前CA、ΔHtSDS 0~3。结论使用重组人生长激素治疗GHD患儿,所获效果明显,检测患者IGF-1等血清学指标可以有效掌握患者治疗情况,对其疗效造成影响的因素包括GV3、ΔIGF-10~3、治疗前CA、以及ΔHtSDS 0~3。

Objective To investigate the therapeutic effects of recombinant human growth hormone(rhGH)in treatment of growth hormone deficiency(GHD)in children and related influencing factors.Methods Fifty children with GHD who were treated in our hospital from January 2019 to December 2020 were enrolled in the study,who were treated by recombinant human growth hormone.The therapeutic effects and related influencing factors were observed and analyzed.Results The levels of GV,Ht,HtSDS at 6 months after treatment were significantly higher than those at 3 months after treatment and those before treatment(P<0.05),moreover,which at 3 months after treatment were significantly higher than those before treatment(P<0.05).After treatment,the levels of GV,ΔHt,ΔHtSDS of GHD from 0 to 3 months were significantly higher than those from 3 to 6 months after treatment(P<0.05).The levels of IGF-1,OC,BAP,uric acid and NT-proCNP at 6 months after treatment are significantly higher than those at 3 months after treatment and those before treatment(P<0.05).After treatment,the levels of GV3,ΔHt 0~3,ΔHtSDS 0~3,and FT4 levels before treatment were positively correlated with those of GV6,however,the levels ofΔIGF-10~3,and GH peak are negatively correlated with those of GV6(P<0.05).After treatment the levels of GV3,ΔHt 0~3,ΔHtSDS 0~3 are positively correlated with those ofΔHtSDS 0~6,however,which were negatively correlated with those of CA,BA,ΔHtSDS 0~6 before treatment(P<0.05).In addition GV3,ΔIGF-10~3 were the influencing factors on GV6,and the levels of CA,ΔHtSDS 0~3 were the influencing factors onΔHtSDS 0~6.Conclusion The recombinant human growth hormone has obvious therapeutic effects on GHD in children,and the levels of GV3,ΔIGF-10~3,CA andΔHtSDS 0~3 before treatment are the influencing factors on thecurative effects.