Tönshoff B, Tönshoff C, Mehls O, Pinkowski J, Blum W F, Heinrich U, Stöver B, Gretz N
Division of Paediatric Nephrology, University Children's Hospital, Heidelberg, Federal Republic of Germany.
Eur J Pediatr. 1992 Aug;151(8):601-7. doi: 10.1007/BF01957731.
Impaired growth and stunting remains a major therapeutic problem in children with chronic renal failure (CRF). Recombinant human growth hormone (rhGH) treatment may be beneficial, but concern has been raised about possible side-effects, i.e. deterioration of renal function and glucose intolerance. We have treated 10 prepubertal children with CRF (median age 7.5 [1.7-10.0] years) with 4 IU rhGH/m2 per day s.c. over a period of 1 year. Height velocity increased significantly (P less than 0.03) from basal 4.6 (2.0-14.0) cm/year to 9.7 (6.8-17.6) cm/year. Height velocity SDS for chronological age and for bone age increased in all children from basal median -2.3 to +3.8 (P less than 0.005). Median glomerular filtration rate (GFR) measured by single injection inulin clearance at onset was 18 (11-66) ml/min per 1.73 m2 and did not change significantly during the treatment year. The loss of GFR as estimated by creatinine clearance was similar during the treatment year (median loss 1.3 ml/min per 1.73 m2) compared to the year before treatment (median loss 3.7 ml/min per 1.73 m2). Serum glucose levels during an oral glucose tolerance test did not change, but fasting as well as stimulated insulin levels increased significantly with time during the study period. It is concluded that the rhGH regimen employed was remarkably effective in improving growth velocity in children with CRF without adversely affecting GFR. Glucose homeostasis remained stable, but at the expense of increased serum insulin levels.
生长发育受损和发育迟缓仍是慢性肾衰竭（CRF）患儿的一个主要治疗难题。重组人生长激素（rhGH）治疗可能有益，但人们对其可能的副作用，即肾功能恶化和葡萄糖耐量异常表示担忧。我们对10名青春期前CRF患儿（中位年龄7.5[1.7 - 10.0]岁）进行了为期1年的治疗，每天皮下注射4 IU rhGH/m²。身高增长速度从基线时的4.6（2.0 - 14.0）cm/年显著增加（P < 0.03）至9.7（6.8 - 17.6）cm/年。所有患儿按实际年龄和骨龄计算的身高增长速度标准差评分从基线时的中位数 -2.3增至 +3.8（P < 0.005）。治疗开始时通过单次注射菊粉清除率测得的中位肾小球滤过率（GFR）为18（11 - 66）ml/min per 1.73 m²，在治疗期间无显著变化。与治疗前一年相比，治疗期间通过肌酐清除率估算的GFR下降情况相似（中位下降1.3 ml/min per 1.73 m² vs 治疗前一年中位下降3.7 ml/min per 1.73 m²）。口服葡萄糖耐量试验期间血清葡萄糖水平未改变，但在研究期间空腹及刺激后胰岛素水平随时间显著升高。结论是，所采用的rhGH治疗方案在改善CRF患儿生长速度方面非常有效，且未对GFR产生不利影响。葡萄糖稳态保持稳定，但代价是血清胰岛素水平升高。
