因头颅放疗导致生长激素（GH）缺乏接受GH治疗后的成人身高。

Adult height after growth hormone (GH) treatment for GH deficiency due to cranial irradiation.

作者信息

Adan L, Sainte-Rose C, Souberbielle J C, Zucker J M, Kalifa C, Brauner R

机构信息

Pediatric Endocrinology Department, Université René Descartes and Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris, France.

出版信息

Med Pediatr Oncol. 2000 Jan;34(1):14-9. doi: 10.1002/(sici)1096-911x(200001)34:1<14::aid-mpo3>3.0.co;2-w.

DOI:10.1002/(sici)1096-911x(200001)34:1<14::aid-mpo3>3.0.co;2-w

PMID:10611579

Abstract

BACKGROUND

The indications and factors affecting the growth in response to treatment with growth hormone (GH) of patients with cranial irradiation-induced GH deficiency remain unclear.

PROCEDURE

The adult heights of 56 patients treated with GH (0.4-0.6 U/kg/week) as daily sc injections were analysed. They had been given 18 or 24 Grays (Gy) cranial irradiation for leukemia (group 1, 26 cases), 50 +/- 1 Gy for various tumors (group 2, 13 cases), 46 +/- 1 Gy for retinoblastoma (group 3, 8 cases), or 34 +/- 2 Gy with spinal irradiation for medulloblastoma (group 4, 9 cases). Twenty- five of these 56 patients had early puberty and were also treated with gonadotropin-releasing hormone (GnRH) analog.

RESULTS

The standing (-1.0 +/- 0.2 in group 1, -0.7 +/- 0.3 in group 2, -1.1 +/- 0.3 in group 3, and -2.0 +/- 0.4 SD in group 4) and sitting (-1.8 +/- 0.2 in group 1, -0.4 +/- 0.4 in group 2, -1.2 +/- 0.4 in group 3, and -3. 4 +/-0.4 SD in group 4) adult heights were shor ter (P < 0.05 for standing and P < 0.001 for sitting heights) for group 4 than for each of the other groups. Of the 47 patients given cranial (and not craniospinal) irradiation, sitting adult height was shorter (P = 0. 02) and the difference between standing adult and target heights greater (P = 0.03) in those patients in whom puberty occurred at a normal age than in those treated with GnRH analog. Conclusion. The incomplete catch-up of growth seems to be mainly due to the reduction in sitting height of patients given spinal irradiation and in whom puberty occurred at a normal age. This suggests that GnRH analog treatment should be more widely used to treat children with early and/or rapidly progressing puberty after cranial irradiation.

摘要

背景

颅脑照射所致生长激素（GH）缺乏患者接受GH治疗的适应证及影响生长反应的因素仍不明确。

方法

分析56例接受GH（0.4 - 0.6 U/kg/周）每日皮下注射治疗患者的成人身高。他们因白血病接受18或24格雷（Gy）颅脑照射（第1组，26例），因各种肿瘤接受50±1 Gy照射（第2组，13例），因视网膜母细胞瘤接受46±1 Gy照射（第3组，8例），或因髓母细胞瘤接受34±2 Gy照射并联合脊髓照射（第4组，9例）。这56例患者中有25例青春期提前，同时接受促性腺激素释放激素（GnRH）类似物治疗。

结果

第4组患者的站立位成人身高（第1组为 - 1.0±0.2标准差，第2组为 - 0.7±0.3标准差，第3组为 - 1.1±0.3标准差，第4组为 - 2.0±0.4标准差）和坐位成人身高（第1组为 - 1.8±0.2标准差，第2组为 - 0.4±0.4标准差，第3组为 - 1.2±0.4标准差，第4组为 - 3.4±0.4标准差）均低于其他各组（站立位P < 0.05，坐位P < 0.001）。在47例接受颅脑（而非全脑脊髓）照射的患者中，青春期正常出现的患者坐位成人身高较短（P = 0.02），站立位成人身高与目标身高的差值更大（P = 0.03），这一情况在接受GnRH类似物治疗的患者中则不然。结论：生长追赶不完全似乎主要是由于接受脊髓照射且青春期正常出现的患者坐位身高降低。这表明GnRH类似物治疗应更广泛地用于治疗颅脑照射后青春期提前和/或进展迅速的儿童。