游离甲状腺素、促甲状腺激素、糖化血红蛋白、胰岛素样生长因子-1对重组人生长激素长期治疗矮小症患儿的评估价值

Evaluation value of free thyroxine,thyrotropin,glycosylated hemoglobinand insulin-like growth factor-1 in long-term treatment of children with short stature by recombinant human growth hormone

目的:探讨游离甲状腺素(FT4)、促甲状腺激素(TSH)及糖化血红蛋白(HbA1c)、胰岛素样生长因子-1(IGF-1)在评估重组人生长激素(Recombinant Human Growth Hormone,rhGH)长期治疗矮小症患儿中的临床价值。方法:选取2018年12月至2020年1月于我院进行治疗的43例矮小症患儿作为观察组,给予rhGH治疗;再选取50例同时期于我院进行健康体检儿童作为对照组。检测并比较两组研究对象游离三碘甲状腺原氨酸(FT3)、FT4和TSH、HbA1c、IGF-1的水平;比较观察组治疗前、治疗3、6、12、24个月后生长发育情况(身高、体质量、骨龄、生长速度),HbA1c、IGF-1和胰岛素样生长因子结合蛋白-3(IGFBP3)水平,甲状腺功能指标(FT3、FT4、TSH),骨代谢和骨吸收指标[碱性磷酸酶(AKP)、胶原羧基末端肽同分异构体(CTX)、骨钙素(OC)]水平。结果:两组研究对象FT3、FT4、TSH、HbA1c水平比较差异无统计学意义(P>0.05);观察组IGF-1水平低于对照组(P<0.05)。与治疗前相比,观察组治疗3、6、12、24个月后身高、体质量、骨龄生长速率均更高(P<0.05),不同时间身高、体质量、骨龄和生长速率组间比较差异有统计学意义(P<0.05),且均呈增长趋势;HbA1c水平比较差异无统计学意义(P>0.05),不同时间组间比较差异无统计学意义(P>0.05);IGF-1、IGFBP3水平均更高(P<0.05),不同时间组间比较差异有统计学意义(P<0.05);FT3、FT4和TSH水平比较差异无统计学意义(P>0.05),不同时间FT3、FT4和TSH水平组间比较差异无统计学意义(P>0.05);AKP、CTX和OC水平明显升高(P<0.05),不同时间AKP、CTX和OC水平组间比较差异具有统计学意义(P<0.05)。结论:应用rhGH长期治疗矮小症患儿对患儿甲状腺功能、糖代谢功能无明显不良影响,患儿生长发育情况明显改善,可以通过持续检测IGF-1、IGFBP3及骨代谢和吸收水平了解治疗效果。

Objective:To investigate the clinical value of FT4,TSH,glycosylated hemoglobin and IGF-1 in evaluating the long-term treatment of children with short stature by recombinant human growth hormone.Methods:A total of short stature children treated in our hospital from December 2018 to January 2020 were selected as the observation group,and then 50 children were selected for health care in our hospital during the same period.Physical examination children were taken as control group,and free triiodothyronine(FT3),free thyroxine(FT4),thyroid-stimulating hormone(TSH),glycosylated hemoglobin(HbA1c)and insulin-like growth factor-1 were detected and compared between the two groups.(IGF-1)FT4,TSH,HbA1c and IGF-1 levels.The growth and development(height,body mass,bone age,growth rate),HbA1c,IGF-1 and insulin-like growth factor-binding protein-3(IGFBP3)levels of the observation group were compared before treatment and after 3,6,12,and 24 months of treatment thyroid function indexes(FT3,FT4,TSH),bone metabolism and bone resorption indexes\levels.Results:There was no significant difference in the levels of FT3,FT4,TSH and HbA1c between the two groups(P>0.05).The IGF-1 level in the observation group was lower than that in the control group(P<0.05).Compared with before treatment,the height,body mass,and bone age growth rate of observation group were higher after 3,6,12,and 24 months of treatment,and the differences were statistically significant(P<0.05).The difference in growth rate between groups was statistically significant(P<0.05),and all showed an increasing trend.Compared with before treatment,there was no significant difference in HbA1c levels in the observation group at 3,6,12,and 24 months after treatment(P>0.05),and there was no significant difference between groups at different times(P>0.05).Compared with before,the levels of IGF-1 and IGFBP3 were higher at 3,6,12,and 24 months after treatment(P<0.05),and there were significant differences between groups at different times(P<0.05).Compared with before treatment,there was no significant difference in the levels of FT3,FT4 and TSH in the observation group after 3,6,12,and 24 months of treatment(P>0.05),and there was no difference in the levels of FT3,FT4 and TSH between groups at different times.Statistical significance(P>0.05).Compared with before treatment,the levels of AKP,CTX and OC in the observation group were significantly increased after 3,6,12,and 24 months of treatment(P<0.05).Conclusion:The long-term treatment of children with short stature with recombinant human growth hormone has no obvious adverse effects on the thyroid function and glucose metabolism of the children,and the growth and development of the children are significantly improved.Continuous detection of IGF-1,IGFBP3,bone metabolism and absorption levels can be achieved.Learn about treatment effects.