Haffner D, Schaefer F, Nissel R, Wühl E, Tönshoff B, Mehls O
Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
N Engl J Med. 2000 Sep 28;343(13):923-30. doi: 10.1056/NEJM200009283431304.
Growth hormone treatment stimulates growth in short children with chronic renal failure. However, the extent to which this therapy increases final adult height is not known.
We followed 38 initially prepubertal children with chronic renal failure treated with growth hormone for a mean of 5.3 years until they reached their final adult height. The mean (+/-SD) age at the start of treatment was 10.4+/-2.2 years, the mean bone age was 7.1+/-2.3 years, and the mean height was 3.1+/-1.2 SD below normal. Fifty matched children with chronic renal failure who were not treated with growth hormone served as controls.
The children treated with growth hormone had sustained catch-up growth, whereas the control children had progressive growth failure. The mean final height of the growth hormone-treated children was 165 cm for boys and 156 cm for girls. The mean final adult height of the growth hormone-treated children was 1.6+/-1.2 SD below normal, which was 1.4 SD above their standardized height at base line (P< 0.001). In contrast, the final height of the untreated children (2.1+/-1.2 SD below normal) was 0.6 SD below their standardized height at base line (P<0.001). Although prepubertal bone maturation was accelerated in growth hormone-treated children, treatment was not associated with a shortening of the pubertal growth spurt. The total height gain was positively associated with the initial target-height deficit and the duration of growth hormone therapy and was negatively associated with the percentage of the observation period spent receiving dialysis treatment.
Long-term growth hormone treatment of children with chronic renal failure induces persistent catch-up growth, and the majority of patients achieve normal adult height.
生长激素治疗可促进慢性肾衰竭矮小儿童的生长。然而，这种治疗对最终成年身高增加的程度尚不清楚。
我们对38名最初处于青春期前的慢性肾衰竭儿童进行了平均5.3年的生长激素治疗随访，直至他们达到最终成年身高。治疗开始时的平均（±标准差）年龄为10.4±2.2岁，平均骨龄为7.1±2.3岁，平均身高比正常低3.1±1.2标准差。50名匹配的未接受生长激素治疗的慢性肾衰竭儿童作为对照。
接受生长激素治疗的儿童实现了持续的追赶生长，而对照儿童则出现了进行性生长迟缓。接受生长激素治疗的儿童的平均最终身高，男孩为165厘米，女孩为156厘米。接受生长激素治疗的儿童的平均最终成年身高比正常低1.6±1.2标准差，比基线时的标准化身高高1.4标准差（P<0.001）。相比之下，未治疗儿童的最终身高（比正常低2.1±1.2标准差）比基线时的标准化身高低0.6标准差（P<0.001）。虽然接受生长激素治疗的儿童青春期前骨成熟加速，但治疗与青春期生长突增缩短无关。总身高增长与初始目标身高 deficit和生长激素治疗持续时间呈正相关，与透析治疗观察期所占百分比呈负相关。
对慢性肾衰竭儿童进行长期生长激素治疗可诱导持续的追赶生长，且大多数患者可达到正常成年身高。
