生长激素治疗特发性矮小和生长激素缺乏症并发脊柱侧凸的研究进展

Research progress on growth hormone therapy for idiopathic short stature and growth hormone deficiency complicated by scoliosis

脊柱侧凸表现为脊柱的一个或数个节段向侧方弯曲并伴有椎体旋转和矢状面上失衡,病因复杂,先天性椎体异常、神经系统病变导致椎旁肌左右不对称、骨组织营养不良或代谢障碍等均可引起脊柱侧凸。生长激素是促进人体生长发育,尤其是对骨骼生长具有关键作用一种肽类激素。对处于快速生长阶段的儿童或青少年,如体内生长激素分泌不足,则可能会导致特发性矮小(idiopathic short stature,ISS)和生长激素缺乏症(growth hormone deficiency,GHD),临床上主要通过使用重组人生长激素(recombinant human growth hormone,rhGH)进行治疗。既往临床研究显示在使用rhGH治疗ISS和GHD的过程中,很多患儿发生脊柱侧凸或原有的脊柱侧凸进展加重,据此很多学者得出结论:rhGH治疗ISS或GHD时会导致脊柱侧凸的发生或进展。但随着临床统计数据的增多以及研究的进展,许多学者发现rhGH治疗ISS或GHD时仅会使既往患有脊柱侧凸的患者Cobb角增加,而不会导致脊柱侧凸的发生,即不会使脊柱侧凸的患病率增加。目前对以上结论以及发病机制仍存在争议。因此,本文就使用rhGH治疗的患儿发生脊柱侧凸并发症风险的相关性研究进行总结分析,经归纳年龄、性别、体质指数、生长潜力等是在治疗期间导致脊柱侧凸发生或进展的风险因素,并对使用rhGH治疗ISS或GHD的优势及不足进行总结,为今后指导临床提供方向。

Scoliosis is characterized by one or several segments of the spine bending sideways,accompanied by vertebral rotation and sagittal imbalance with complex etiology.Scoliosis can be caused by congenital vertebral abnormalities,asymmetry of the paraspinal muscles due to neurological lesions,and malnutrition or metabolic disorders of bone tissue.Growth hormone is a peptide hormone that plays a key role in promoting human growth and development,especially in bone growth.When the secretion of growth hormone in children or adolescents in the rapid growth stage is insufficient,it may lead to the occurrence of idiopathic short stature(ISS)and growth hormone deficiency(GHD).In clinic,ISS and GHD are mainly treated by recombinant human growth hormone(rhGH).According to some early clinical reports,in the process of rhGH treatment,many patients occur scoliosis or the original scoliosis progression is aggravated.Therefore,many scholars conclude that rhGH treatment of ISS or GHD will lead to the occurrence or development of scoliosis.However,with the increase of clinical statistics and the further progress of research,many scholars found that rhGH treatment of ISS or GHD will only increase the Cobb angle of patients with scoliosis,but will not lead to the occurrence of scoliosis,that is,rhGH treatment of ISS or GHD will not increase the prevalence of scoliosis.At present,whether rhGH treatment of ISS and GHD can lead to scoliosis and aggravation of scoliosis remains controversial.Therefore,this paper summarizes and analyzes the correlation research on the risk of scoliosis complications in children treated with rhGH,and concludes that age,gender,body mass index,and growth potential are risk factors for the development or progression of scoliosis during treatment,and discusses the balance of advantages and disadvantages of using rhGH for ISS or GHD to provide a direction for future clinical guidance.