Tsatsoulis A, Siamopoulou A, Petsoukis C, Challa A, Bairaktari E, Seferiadis K
Endocrine Unit, Department of Medicine, Department of Paediatrics, University of Ioannina, Ioannina, Greece.
Growth Horm IGF Res. 1999 Apr;9(2):143-9. doi: 10.1054/ghir.1999.0099.
The stimulated and spontaneous growth hormone (GH) secretion and the response to GH action were assessed in growth-retarded children with juvenile chronic arthritis (JCA), in order to determine the underlying mechanisms of growth retardation in such children. Six children (4 boys and 2 girls aged 10.7-13.8 years) with active JCA of systemic onset were included in the study which involved: (1) anthropometric measurements; (2) assessment of GH responses to insulin-induced hypoglycaemia and clonidine stimulation; (3) assessment of the nocturnal pulsatile GH secretion by measuring GH in blood samples obtained every 20 min from 20.00 to 08.00 h; and (4) the IGF-I generation test. As a control, the latter test was also performed in eight aged-matched children with physiological delay in puberty. Biosynthetic hGH (0.1 IU/kg BW) was administered s. c. for 4 days and blood samples were taken at baseline and the morning after the last GH injection for measurement of IGF-I and IGFBP-3. All six children with JCA were prepubertal and their growth velocity was <3 cm/year. The GH responses to both stimulation tests were normal (peak GH >20 mU/l). Analysis of the pulsatile GH secretion during the night revealed three-to-four GH pulses of normal amplitude (>20 mU/l). IGF-I (26.7+/-4.6 nmol/l, mean+/-SD) and IGFBP-3 (2.1+/-0.2 mg/l) levels were lower in the patients compared with the controls (43.0+/-3.7 nmol/l and 2.8+/-0.2 mg/l, respectively, P<0.01). Following stimulation with exogenous hGH, there was a significant increase in IGF-I and IGFBP-3 levels in the control group (85 and 73%, respectively), but only a small increase in the patients (31 and 14%). It appears that stimulated and spontaneous GH secretion is normal in children with active systemic JCA, but the response to endogenous and exogenous GH with regard to IGF-I and IGFBP-3 production is impaired, indicating a degree of GH insensitivity in such children.
为了确定患有幼年慢性关节炎（JCA）的生长迟缓儿童生长迟缓的潜在机制，对其刺激和自发性生长激素（GH）分泌以及对GH作用的反应进行了评估。该研究纳入了6名患有全身发作性活动性JCA的儿童（4名男孩和2名女孩，年龄在10.7至13.8岁之间），研究内容包括：（1）人体测量；（2）评估GH对胰岛素诱导的低血糖和可乐定刺激的反应；（3）通过测量从20:00至08:00每20分钟采集的血样中的GH来评估夜间脉冲式GH分泌；以及（4）IGF-I生成试验。作为对照，还对8名年龄匹配的青春期生理性延迟儿童进行了后一项试验。皮下注射生物合成hGH（0.1 IU/kg体重），持续4天，并在基线时以及最后一次GH注射后的早晨采集血样，用于测量IGF-I和IGFBP-3。所有6名患有JCA的儿童均处于青春期前，其生长速度<3厘米/年。两种刺激试验的GH反应均正常（GH峰值>20 mU/l）。夜间脉冲式GH分泌分析显示，有三到四个幅度正常（>20 mU/l）的GH脉冲。与对照组相比，患者的IGF-I（26.7±4.6 nmol/l，平均值±标准差）和IGFBP-3（2.1±0.2 mg/l）水平较低（对照组分别为43.0±3.7 nmol/l和2.8±0.2 mg/l，P<0.01）。外源性hGH刺激后，对照组的IGF-I和IGFBP-3水平显著升高（分别为85%和73%），但患者仅略有升高（分别为31%和14%）。似乎患有活动性全身JCA的儿童刺激和自发性GH分泌正常，但在IGF-I和IGFBP-3产生方面对内源性和外源性GH的反应受损，表明此类儿童存在一定程度的GH不敏感。
