Sas T, Mulder P, Hokken-Koelega A
Department of Pediatrics, Sophia Children's Hospital/Erasmus University, Rotterdam, The Netherlands.
J Clin Endocrinol Metab. 2000 Oct;85(10):3786-92. doi: 10.1210/jcem.85.10.6917.
To assess the effects of long-term continuous GH treatment on body composition, blood pressure (BP), and lipid metabolism in children with short stature born small for gestational age (SGA), body mass index (BMI), skinfold thickness measurements, systemic BP measurements, and levels of blood lipids were evaluated in 79 children with a baseline age of 3-11 yr with short stature (height SD-score, < -1.88) born SGA (birth length SD-score, < -1.88). Twenty-two of the 79 children were GH deficient (GHD). All children participated in a randomized, double-blind, dose-response multicenter GH trial. Four- and 6-yr data were compared between two GH dosage groups (3 vs. 6 IU/m2 body surface/day). Untreated children with short stature born SGA are lean (mean BMI SD-score, -1.3; mean SD-score skinfolds, -0.8), have a higher systolic BP (SD-score, 0.7) but normal diastolic BP (SD-score, -0.1), and normal lipids (total cholesterol, 4.7 mmol/L; low-density lipoprotein, 2.9 mmol/L; high-density lipoprotein, 1.3 mmol/L) compared with healthy peers. During long-term continuous GH treatment, the BMI normalized without overall changes in sc fat compared with age-matched references, whereas the BP SD-score and the atherogenic index decreased significantly. Although the mean 6-yr increase in height SD-score was significantly higher in the children receiving GH treatment with 6 IU/m2 x day (2.7) than in those receiving treatment with 3 IU/m2 day (2.2), no differences in the changes in BMI, skinfold measurements, BP, and lipids were found between the GH dosage groups. The pretreatment SD-scores for BMI, skinfold, and BP, as well as the lipid levels, were not significantly different between GHD and non-GHD children, but after 6 yr of GH treatment the skinfold SD-score and BP SD-score had decreased significantly more in the GHD than in the non-GHD children. Our data indicate that GH treatment has at least up to 6 yr positive instead of negative effects on body composition, BP, and lipid metabolism. In view of the reported higher risk of cardiovascular diseases in later life in children born SGA, further research into adulthood remains warranted.
为评估长期持续生长激素（GH）治疗对小于胎龄儿（SGA）出生的身材矮小儿童身体成分、血压（BP）和脂质代谢的影响，我们对79名基线年龄为3至11岁、身材矮小（身高标准差评分，< -1.88）且为SGA出生（出生身长标准差评分，< -1.88）的儿童进行了体重指数（BMI）、皮褶厚度测量、全身血压测量和血脂水平评估。79名儿童中有22名生长激素缺乏（GHD）。所有儿童均参与了一项随机、双盲、剂量反应多中心GH试验。比较了两个GH剂量组（3 vs. 6 IU/m²体表面积/天）4年和6年的数据。未接受治疗的SGA出生的身材矮小儿童体型偏瘦（平均BMI标准差评分，-1.3；平均皮褶标准差评分，-0.8），收缩压较高（标准差评分，0.7）但舒张压正常（标准差评分，-0.1），与健康同龄人相比血脂正常（总胆固醇，4.7 mmol/L；低密度脂蛋白，2.9 mmol/L；高密度脂蛋白，1.3 mmol/L）。在长期持续GH治疗期间，与年龄匹配的参照标准相比，BMI恢复正常且皮下脂肪无总体变化，而BP标准差评分和致动脉粥样硬化指数显著下降。尽管接受6 IU/m²×天GH治疗的儿童6年身高标准差评分的平均增加（2.7）显著高于接受3 IU/m²/天治疗的儿童（2.2），但GH剂量组之间在BMI、皮褶测量、BP和血脂变化方面未发现差异。GHD和非GHD儿童在BMI、皮褶和BP的预处理标准差评分以及血脂水平方面无显著差异，但在GH治疗6年后，GHD儿童的皮褶标准差评分和BP标准差评分下降幅度明显大于非GHD儿童。我们的数据表明，GH治疗至少在6年内对身体成分、BP和脂质代谢具有积极而非消极影响。鉴于报道称SGA出生的儿童成年后心血管疾病风险较高，对其成年期的进一步研究仍有必要。
