Cole T J, Hindmarsh P C, Dunger D B
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College, London, UK.
Arch Dis Child. 2004 Nov;89(11):1024-7. doi: 10.1136/adc.2003.043406.
To identify factors, particularly the growth hormone (GH) provocation test result, affecting growth response to GH treatment in children with GH deficiency (GHD).
A total of 337 prepubertal GHD patients aged <10 years from the UK Pharmacia KIGS database (GH response to provocation test <20 mU/l).
Annual change in height standard deviation score (SDS) (revised UK reference) in the first and second years of treatment.
Height increased by 0.74 SDS units (SD 0.39) in the first year of treatment and 0.37 units (SD 0.27) in the second. Adjusting for age, height, weight, midparent height, and injection frequency, the strongest predictor of first year growth response was the GH provocation test result; halving the result predicted an extra height increment of 0.09 units (p<0.0001). It predicted the second year response less well (p<0.0002) and after adjusting for the first year response was not predictive at all.
Among patients referred for possible GHD, the GH provocation test, though not a gold standard for diagnosis, is a valuable predictor of growth response in the first year of treatment. A year's treatment is recommended for cases with a marginal provocation test result, with the option to continue treatment if the response is adequate. The value of unified protocols for single or repeated provocation tests needs to be assessed.
确定影响生长激素缺乏症（GHD）患儿对生长激素（GH）治疗生长反应的因素，尤其是GH激发试验结果。
来自英国法玛西亚国际生长研究数据库（对激发试验的GH反应<20 mU/l）的337名10岁以下青春期前GHD患者。
治疗第一年和第二年身高标准差评分（SDS）（修订后的英国参考标准）的年度变化。
治疗第一年身高增加0.74个SDS单位（标准差0.39），第二年增加0.37个单位（标准差0.27）。校正年龄、身高、体重、父母平均身高和注射频率后，第一年生长反应的最强预测因素是GH激发试验结果；结果减半预计身高额外增加0.09个单位（p<0.0001）。它对第二年反应的预测效果较差（p<0.0002），在校正第一年反应后则完全没有预测性。
在因可能患有GHD而转诊的患者中，GH激发试验虽然不是诊断的金标准，但却是治疗第一年生长反应的重要预测指标。对于激发试验结果临界的病例，建议进行一年的治疗，如果反应足够则可选择继续治疗。单一或重复激发试验统一方案的价值需要评估。
