Janssen F, Van Damme-Lombaerts R, Van Dyck M, Hall M, Schurmans T, Herman J, Hooghe L, Van Damme B
Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
Pediatr Transplant. 1997 Nov;1(2):190-6.
We retrospectively analyzed the effects of recombinant human growth hormone (rhGH) in a Belgian population of 36 short children with renal allografts. Seven children were dropped from the growth study: 1 had skeletal dysplasia and in 6 cases rhGH was given for less than 1 yr (1 died, 1 developed genu valgum, 2 were non-compliant and 2 grafts deteriorated). Final height was reached in 17 patients, and 12 children were still growing at the end of the study. Median height standard deviation score (SDS) in the 29 patients was -2.3 at the time of transplantation, and -2.7 when rhGH therapy was initiated. During rhGH therapy (median duration 3.2 yr, range 0.6-7.7 yr), height SDS increased by a mean of 0.4 per year, and bone maturation was not accelerated. Final height reached was 162.7 (149.0-169.5) cm (median SDS -1.8) in males and 151.0 (130.5-169.5) cm (median SDS -1.9) in females. Final height is significantly greater in males than females compared with a historical control group of untreated patients. Final height is within the parental target height range in 6 out of the 17 patients. The increase in height SDS in patients who were at an advanced stage of puberty (Tanner stages 4-5) when rhGH therapy was initiated exceeded our expectations (mean height gain 14.2 cm in boys and 10 cm in girls). In the cohort of 36 children, 4 patients developed an acute allograft rejection, all of whom had an underlying chronic rejection. This resulted in 3 graft losses within 5 yr. Our results indicate that rhGH treatment has a positive effect in short children with renal allografts, even if it is started in late puberty. In the presence of underlying chronic rejection, rhGH treatment needs careful monitoring to minimize the risk of graft loss.
我们回顾性分析了重组人生长激素（rhGH）对比利时36名肾移植矮小儿童的影响。7名儿童退出了生长研究：1名患有骨骼发育异常，6例使用rhGH的时间不足1年（1例死亡，1例出现膝外翻，2例不依从，2例移植肾功能恶化）。17例患者达到了最终身高，12名儿童在研究结束时仍在生长。29例患者移植时的身高标准差评分（SDS）中位数为-2.3，开始rhGH治疗时为-2.7。在rhGH治疗期间（中位持续时间3.2年，范围0.6 - 7.7年），身高SDS平均每年增加0.4，且骨成熟未加速。男性达到的最终身高为162.7（149.0 - 169.5）cm（SDS中位数-1.8），女性为151.0（130.5 - 169.5）cm（SDS中位数-1.9）。与未治疗患者的历史对照组相比，男性的最终身高显著高于女性。17例患者中有6例的最终身高在父母目标身高范围内。开始rhGH治疗时处于青春期晚期（坦纳分期4 - 5期）的患者身高SDS增加超过预期（男孩平均身高增加14.2 cm，女孩平均身高增加10 cm）。在这36名儿童队列中，4例发生了急性移植排斥反应，所有这些患者都有潜在的慢性排斥反应。这导致5年内3例移植肾丢失。我们的结果表明，rhGH治疗对肾移植矮小儿童有积极作用，即使在青春期晚期开始治疗也是如此。在存在潜在慢性排斥反应的情况下，rhGH治疗需要仔细监测，以将移植肾丢失的风险降至最低。
