Hokken-Koelega A C
Afd. Kindergeneeskunde, Erasmus Universiteit en Academisch Ziekenhuis/Sophia Kinderziekenhuis, Rotterdam.
Tijdschr Kindergeneeskd. 1992 Oct;60(5):177-82.
Stunted growth is a serious problem for many children with chronic renal insufficiency (CRI). Dialysis does not improve growth velocity, while renal transplantation does not always result in better growth either. The pathogenesis of the growth retardation is unknown, but growth hormone (GH) secretion and plasma levels of insulin-like growth factors (IGF) I and -II appear to be normal. Elevated levels of IGF-binding proteins may be involved in the growth retardation. Several 2-year studies have shown that impressive increase in growth velocity can be achieved with GH therapy with 28 IU/m2/week, without significant changes in renal function or adverse events. A lower GH dose of 14IU/m2/week was not able to maintain catch-up growth for longer than 6 months in children older than 4 years. Bone maturation appears unaffected, suggesting improved final height. In children with CRI GH-treatment is best started following 1 year of marked growth retardation. Preliminary results of GH-treatment in children after renal transplantation seem promising, but long-term data are needed before definitive conclusions can be drawn.
生长发育迟缓是许多慢性肾功能不全（CRI）儿童面临的严重问题。透析并不能提高生长速度，而肾移植也并非总能带来更好的生长情况。生长发育迟缓的发病机制尚不清楚，但生长激素（GH）分泌以及胰岛素样生长因子（IGF）-I和-II的血浆水平似乎正常。IGF结合蛋白水平升高可能与生长发育迟缓有关。多项为期两年的研究表明，采用28 IU/m²/周的生长激素治疗可显著提高生长速度，且肾功能无明显变化，也未出现不良事件。对于4岁以上儿童，每周14IU/m²的较低生长激素剂量无法维持追赶生长超过6个月。骨成熟似乎未受影响，这表明最终身高可能会有所改善。对于慢性肾功能不全儿童，生长激素治疗最好在出现明显生长发育迟缓1年后开始。肾移植后儿童生长激素治疗的初步结果似乎很有前景，但在得出明确结论之前还需要长期数据。
