Rodríguez-Soriano J, Vallo A, Quintela M J, Málaga S, Loris C
Division of Pediatric Nephrology, Department of Pediatrics, Hospital de Cruces and Basque University School of Medicine, Bilbao, País Vasco, Spain.
Nephron. 2000 Nov;86(3):266-73. doi: 10.1159/000045780.
Assessment of final adult height and its predictive factors in children transplanted (RTx) and followed up in a single center.
A cohort of 32 patients (17 boys, 15 girls) who received RTx before the age of 15 years and had reached a final adult height was selected. Twenty patients received a single RTx, 9 patients received two RTx, and 3 patients received three RTx. Seven children were transplanted preemptively, while the remaining 25 children received peritoneal dialysis for relatively short periods of time. In 11 patients, recombinant human growth hormone (rhGH) was administered either before (n = 8) or after (n = 3) RTx.
In 13 patiens (41%), the final height standard deviation score for chronological age (hSDS) was -2.3+/-0.5, below the 95% confidence limits for target height (group A), while in 19 patients (59%), it was -0.7+/-0.8, within the 95% confidence limits for target height (group B). The hSDS values at the start of dialysis and at the time of first RTx were significantly lower in group A than in group B. A higher hSDS at the start of dialysis and at the time of first RTx had a significant positive influence on the final height (FH), whereas a longer duration of dialysis had a significant negative effect on the FH. Administration of rhGH after RTx played an important role in the achievement of a normal FH in 3 girls. No differences were observed between group A and B with respect to age at start of dialysis, chronological or bone age at first RTx, number of rejection episodes, duration of the study period from last RTx to FH, glomerular filtration rate during this study period, or percentage of time on prednisone therapy.
The FH is almost exclusively predetermined by the height achieved at the start of dialysis and at the time of first RTx. Therefore, to reach target adult height after RTx, the best strategy is to shorten the time of dialysis and to start rhGH administration at a young age and as early as possible during the course of chronic renal failure. Administration of rhGH after RTx is also highly effective, but, given its potential danger, still remains a matter of investigation.
评估在单一中心接受移植（肾移植）并随访的儿童的最终成人身高及其预测因素。
选取一组32例患者（17例男孩，15例女孩），他们在15岁之前接受了肾移植且已达到最终成人身高。20例患者接受了单次肾移植，9例患者接受了两次肾移植，3例患者接受了三次肾移植。7例儿童接受了抢先移植，其余25例儿童接受了较短时间的腹膜透析。11例患者在肾移植前（n = 8）或肾移植后（n = 3）接受了重组人生长激素（rhGH）治疗。
13例患者（41%）按实际年龄计算的最终身高标准差评分（hSDS）为-2.3±0.5，低于目标身高的95%置信区间（A组），而19例患者（59%）的hSDS为-0.7±0.8，在目标身高的95%置信区间内（B组）。A组透析开始时和首次肾移植时的hSDS值显著低于B组。透析开始时和首次肾移植时较高的hSDS对最终身高（FH）有显著的正向影响，而较长的透析时间对FH有显著的负向影响。肾移植后给予rhGH对3例女孩达到正常FH起到了重要作用。A组和B组在透析开始时的年龄、首次肾移植时的实际年龄或骨龄、排斥反应发作次数、从最后一次肾移植到FH的研究期持续时间、该研究期内的肾小球滤过率或泼尼松治疗时间百分比方面均未观察到差异。
最终身高几乎完全由透析开始时和首次肾移植时所达到的身高预先决定。因此，为了在肾移植后达到目标成人身高，最佳策略是缩短透析时间，并在慢性肾衰竭病程中尽早且在年轻时开始给予rhGH。肾移植后给予rhGH也非常有效，但鉴于其潜在风险，仍有待研究。
