Schwarze C P, Wollmann H A, Binder G, Ranke M B
Department of Paediatric Endocrinology, University Children's Hospital, Tübingen, Germany.
Acta Paediatr Suppl. 1999 Feb;88(428):200-8. doi: 10.1111/j.1651-2227.1999.tb14392.x.
The present study included a cohort of 42 children aged between 1.7 and 15.4 years, who presented with short stature and growth failure. Basal and generated serum levels of insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 (IGFBP-3), measured in an IGF generation test following four or seven daily injections of growth hormone (GH), 0.1 IU/kg (0.033 mg/kg), were analysed in these patients. The growth response to 1 year of GH treatment, 0.6 IU/kg/week (0.2 mg/kg/week), was also investigated. Median height velocity of these patients increased from -1.6 SDS (range, -4.6 to -0.3 SDS) to 3.3 SDS (range, -0.2 to 7.1 SDS) after 1 year of GH treatment, and median height SDS increased by 0.7 SDS (range, 0.1 to 2.2 SDS). Strong correlations were observed between basal and generated IGF-I and IGFBP-3 levels. The increase in IGFBP-3 levels in response to GH in the generation test was a strong predictor of the growth response to GH therapy. All the patients in the present study could be differentiated from patients with GH insensitivity syndrome (GHIS) using the criteria of a diagnostic scoring system for GHIS. The most valuable parameters were the increases in IGF-I and IGFBP-3 levels in the generation test, which excluded 95.2% of the patients from a diagnosis of GHIS.
本研究纳入了42名年龄在1.7至15.4岁之间、身材矮小且生长发育迟缓的儿童。对这些患者进行了分析，在每日注射生长激素（GH）0.1 IU/kg（0.033 mg/kg），共注射4次或7次后进行的IGF生成试验中，测量基础和生成的血清胰岛素样生长因子-I（IGF-I）及IGF结合蛋白-3（IGFBP-3）水平。还研究了这些患者对1年GH治疗（0.6 IU/kg/周，即0.2 mg/kg/周）的生长反应。经过1年的GH治疗后，这些患者的身高速度中位数从-1.6 SDS（范围为-4.6至-0.3 SDS）增至3.3 SDS（范围为-0.2至7.1 SDS），身高SDS中位数增加了0.7 SDS（范围为0.1至2.2 SDS）。观察到基础和生成的IGF-I及IGFBP-3水平之间存在强相关性。在生成试验中，IGFBP-3水平对GH的反应增加是GH治疗生长反应的有力预测指标。本研究中的所有患者均可根据GH不敏感综合征（GHIS）诊断评分系统的标准与GHIS患者区分开来。最有价值的参数是生成试验中IGF-I和IGFBP-3水平的增加，这可将95.2%的患者排除GHIS诊断。
