胰岛素低血糖-生长激素激发试验中采用不同胰岛素计算方法在矮身材儿童中的临床效果对比

Comparative Clinical Outcomes in Insulin Tolerance Test Using Different Insulin Calculation Methods in Children with Short Stature

目的:比较采用不同胰岛素计算方法的胰岛素低血糖-生长激素激发试验(ITT)间的临床效果。方法:选取2019年6月~2023年3月期间于某院内分泌及代谢病科因矮身材就诊,并需要行ITT的107例患儿作为研究对象,按照胰岛素计算方法分为传统ITT组(n=30)和优化ITT组(n=77)。传统ITT组参照指南推荐的胰岛素剂量,优化ITT组采用优化后的个体化胰岛素剂量。比较两组GH峰值、达峰时间、单次注射胰岛素成功率、试验阳性率、所用胰岛素剂量、安全性及住院天数。结果:两组GH峰值、达峰时间、单次注射激发成功率及试验阳性率比较均无统计学差异(P>0.05);传统ITT组所用胰岛素剂量[(9.48±4.41)U/kg]高于优化ITT组所用胰岛素剂量[(7.46±4.49)U/kg,P<0.05];传统ITT组不良反应发生率(26.7%)高于优化ITT组(10.4%,P<0.05);传统ITT组住院天数短于优化ITT组(P<0.05)。结论:进行ITT时,采用优化后的个体化胰岛素激发量与参照指南推荐计算的胰岛素剂量相比,在达到相同试验效果的同时可保障患儿的用药安全。

Objective:To compare the clinical outcomes in the insulin tolerance test(ITT)using different insulin calculation methods.Methods:A total of 107 children who visited with the department of endocrine and metabolic diseases in a hospial from June 2019 to March 2023 due to short stature and required ITT were selected and assigned into traditional ITT group(n=30)and optimized ITT group(n=77)on the basis of the insulin calculation method.The traditional ITT group was treated at the insulin dose as recommended in the guidelines,whereas the optimized ITT group was treated at the optimized and individualized insulin dose.The GH peak value,the time to peak,success rate of single-dose insulin injection,positive rate,dose of insulin used,safety and the duration of hospitalization were compared between the two groups.Results:There was no statistically significant difference in GH peak value,time to peak,successful provocation rate of single-dose injection and positive rate between the two groups(P>0.05).The insulin dose in the traditional ITT group[(9.48±4.41)U/kg]was higher than that in the optimized ITT group[(7.46±4.49)U/kg,P<0.05].The incidence of adverse reactions in the traditional ITT group(26.7%)was higher than that in the optimized ITT group(10.4%,P<0.05).The duration of hospitalization in the traditional ITT group was shorter than that in the optimized ITT group(P<0.05).Conclusion:In the ITT,the optimized and individualized insulin dose demonstrated comparable outcome as compared with the recommended insulin dose calculated by reference to the guidelines,and meanwhile guaranteed children's medication safety.