矮小症患儿的临床特征及重组人生长激素联合来曲唑对p21waf/cip1、25-OH-D水平的影响

Clinical Characteristics of Children with Short Stature and the Effect of Recombinant Human Growth Hormone Combined with Letrozole on p21waf/cip1,25-OH-D Levels

目的探讨重组人生长激素(rh-GH)联合来曲唑治疗特发性矮小症(ISS)的临床价值及对患儿p21waf/cip1、25羟基维生素D(25-OH-D)水平的影响。方法选取86例ISS患儿,随机分为对照组与研究组,各43例;对照组给予rh-GH,研究组联合来曲唑治疗,疗程均为12个月。比较两组的骨龄、Ⅰ型胶原氨基酸延长肽(PINP)、预测终身高、p21waf/cip1、骨碱性磷酸酶(BALP)、25-OH-D、骨钙素(OC)、临床疗效及不良反应。结果研究组的疗效优良率(95.35%Vs 76.74%)高于对照组(P<0.05)。治疗前,两组的骨龄、PINP、预测终身高、BALP、OC、p21waf/cip1蛋白、25-OH-D差异无统计学意义(P>0.05);治疗12个月后,研究组的PINP、骨龄、25-OH-D、OC、预测终身高大于对照组,研究组的p21waf/cip1蛋白、BALP小于对照组,差异有统计学意义(P<0.05)。两组的总不良反应率(11.63%VS 6.98%)差异无统计学意义(P>0.05)。结论在rh-GH基础上联合来曲唑治疗ISS的疗效良好,能够有效改善患儿骨代谢指标与25-OH-D、p21waf/cip1水平,促进患儿身高增长与骨骼发育,提高患者终身高值。

Objective To investigate the clinical value of recombinant human growth hormone(RH GH)combined with letrozole in the treatment of idiopathic short stature(ISS)and its effect on the levels of p21waf/cip1 and 25 hydroxy Vitamin D(25-OH-D)in children.Methods 86 children with ISS were selected and randomly divided into control group and study group,43 cases each;The control group was given RH GH,and the study group was treated with letrozole for 12 months.Bone age,PINP,predicted lifetime height,p21waf/cip1,bone alkaline phosphatase(BALP),25-OH-D,osteocalcin(OC),clinical efficacy and adverse reactions were compared between the two groups.Results The excellent and good rate of curative effect in the study group(95.35%vs 76.74%)was higher than that in the control group(P<0.05).Before treatment,there was no significant difference in bone age,PINP,predicted final height,BALP,OC,p21waf/cip1 protein,25-OH-D between the two groups(P>0.05);After 12 months of treatment,the PINP,bone age,25-OH-D,OC and predicted final height of the study group were larger than those of the control group,and the p21waf/cip1 protein and BALP of the study group were smaller than those of the control group,with statistical significance(P<0.05).There was no significant difference in the total adverse reaction rate between the two groups(11.63%vs 6.98%)(P>0.05).Conclusion Combined with letrozole on the basis of RH GH has a good effect on ISS,which can effectively improve the bone metabolism index and 25-OH-D,p21waf/cip1 levels of children,promote the height growth and bone development of children,and improve the lifelong height value of patients.