生长激素干预对非酒精性脂肪肝患儿心血管功能及代谢相关指标的影响研究

Effect of growth hormone intervention on cardiovascular function and metabolism related indexes in children with non-alcoholic fatty liver disease

目的探讨生长激素(GH)干预对非酒精性脂肪肝(NAFLD)患儿心血管功能及代谢相关指标的影响。方法纳入2021年10月至2022年10月杭州市儿童医院儿科收治的NAFLD患儿96例,根据随机数字表法分为GH组与常规组各48例。常规组采用饮食运动疗法,GH组采用饮食运动疗法+重组人生长激素(rhGH)治疗。比较两组患儿治疗前后颈动脉内中膜厚度(cIMT)、内皮依赖性血流介导的血管舒张功能(FMD)及TG、TC、LDL-C、HDL-C、AST、ALT、γ-谷氨酰转移酶(GGT)、胰岛素样生长因子-1(IGF-1)、空腹胰岛素(FINS)、FBG、胰岛素抵抗指数(HOMA-IR),记录两组不良反应发生情况。结果两组患儿治疗3、6个月的cIMT低于治疗前,且GH组低于常规组,两组患儿治疗6个月的FMD高于治疗前及治疗3个月,且GH组高于常规组(均P<0.05)。GH组治疗3、6个月的LDL-C低于常规组,HDL-C高于常规组(均P<0.05)。两组患儿治疗6个月的AST、ALT、GGT低于治疗前,且GH组GGT低于常规组(均P<0.05)。两组患儿治疗6个月的IGF-1水平高于治疗前,且GH组高于常规组(均P<0.05)。两组患儿治疗6个月的FINS、FBG、HOMA-IR低于治疗前,且GH组FINS、HOMA-IR低于常规组(均P<0.05)。GH组不良反应发生率(14.58%)高于常规组(0)(P<0.05)。结论GH对儿童NAFLD有一定治疗价值,能进一步改善患儿的心血管功能、糖脂代谢与IGF-1、GGT水平,但可能引起关节疼痛、肌肉酸痛,临床需密切观察患儿的不良反应情况。

Objective To investigate the effects of growth hormone(GH)intervention on cardiovascular function and metabolic indexes in children with non-alcoholic fatty liver disease(NAFLD).Methods A total of 96 children with NAFLD admitted to the Department of Pediatrics of Hangzhou Children's Hospital from October 2021 to October 2022 were prospectively included and divided into GH group and conventional group with 48 cases in each group according to random number table method.The conventional group was treated with diet and exercise therapy,while the GH group was treated with diet and exercise therapy plus recombinant human growth hormone(rhGH).Carotid intima media thickness(cIMT),endothelium-dependent blood flow mediated vasodilation(FMD),triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),aspartate transaminase(AST),alanine transaminase(ALT),gamma glutamyltransferase(GGT),insulin-like growth factor-1(IGF-1),fasting insulin(FINS),fasting blood glucose(FBG)and homeostasis model assessment of insulin resistance(HOMA-IR)were compared between the two groups before and after treatment.The adverse reactions of the two groups were recorded.Results The cIMT at 3 and 6 months of treatment in the two groups was both lower than that before treatment,and the GH group was lower than the conventional group;the FMD at 6 months of treatment in the two groups was both higher than that before treatment and 3 months after treatment,with that of the GH group higher than the conventional group(all P<0.05).LDL-C in GH group was lower than that in conventional group at 3 and 6 months of treatment,while HDL-C was higher than that in conventional group(all P<0.05).After 6 months of treatment,AST,ALT and GGT in both groups were lower than those before treatment,with GGT in GH group lower than that in conventional group(all P<0.05).The IGF-1 level in the two groups after 6 months of treatment was higher than that before treatment,and the GH group had higher IGF-1 level than the conventional group(all P<0.05).After 6 months of treatment,FINS,FBG and HOMA-IR in both groups were lower than those before treatment,and FINS and HOMA-IR in GH group were lower when compared with conventional group(all P<0.05).The adverse reaction rate of GH group was higher than that of the conventional group(14.58%vs.0,P<0.05).Conclusion GH has certain therapeutic value in children with NAFLD,which can further improve the cardiovascular function,glucose and lipid metabolism,and IGF-1 and GGT levels in children,but it may cause joint pain and muscle soreness.The adverse reactions of children need to be closely observed in clinic.