Zadik Z, Landau H, Limoni Y, Lieberman E
Department of Pediatrics, Kaplan Hospital, Rehovot, Israel.
J Pediatr. 1992 Jul;121(1):44-8. doi: 10.1016/s0022-3476(05)82539-9.
Sixty prepubertal short children (39 boys) with heights less than 2 SD for age and gender were treated daily for 1 year with recombinant human growth hormone (GH), either 0.1 IU/kg (group 0.1, n = 32) or 0.05 IU/kg (group 0.05, n = 28). Reserve of GH was determined by at least one GH provocative stimulus and 24-hour continuous blood withdrawal to determine the integrated concentration of GH (IC-GH). All participants had a GH response to provocative tests greater than 10 micrograms/L. The height velocity (mean +/- SD) of the group as a whole increased from 4.46 +/- 1.02 to 7.59 +/- 1.65 cm/yr (p less than 0.001). The growth velocity of group 0.1 was significantly greater than that of group 0.05 (8.1 +/- 1.5 vs 7.0 +/- 1.65 cm/yr; p less than 0.01). Bone age did not advance more than 1 year during the treatment period. Growth velocity after 1 year of GH therapy was inversely correlated with the IC-GH in both groups, as was the pretreatment height velocity. We found no correlation of growth velocity during GH therapy with other measures such as parental heights, bone age/chronologic age ratio, maximal GH response to provocative tests, chronologic age, or pretreatment insulin-like growth factor I levels. We conclude that the best predictors for the 1-year growth outcome of short children with a normal GH response to provocative tests are the pretreatment growth velocity and the IC-GH. The short-term benefit from GH therapy in children with a normal growth velocity and a normal IC-GH is poor, whereas marked growth acceleration is noted in children with a low growth velocity and a low 24-hour IC-GH.
60名青春期前身材矮小的儿童（39名男孩），其身高低于年龄和性别的2个标准差，每天接受重组人生长激素（GH）治疗1年，剂量分别为0.1 IU/kg（0.1组，n = 32）或0.05 IU/kg（0.05组，n = 28）。通过至少一项GH激发试验和24小时连续采血来测定GH储备，以确定GH的整合浓度（IC-GH）。所有参与者对激发试验的GH反应均大于10微克/升。整个组的身高增长速度（平均值±标准差）从4.46±1.02厘米/年增加到7.59±1.65厘米/年（p < 0.001）。0.1组的生长速度显著高于0.05组（8.1±1.5 vs 7.0±1.65厘米/年；p < 0.01）。治疗期间骨龄进展不超过1年。两组在GH治疗1年后的生长速度与IC-GH呈负相关，治疗前的身高增长速度也是如此。我们发现GH治疗期间的生长速度与其他指标无相关性，如父母身高、骨龄/实足年龄比值、对激发试验的最大GH反应、实足年龄或治疗前胰岛素样生长因子I水平。我们得出结论，对于对激发试验有正常GH反应的身材矮小儿童，1年生长结果的最佳预测指标是治疗前的生长速度和IC-GH。生长速度正常且IC-GH正常的儿童从GH治疗中获得的短期益处不佳，而生长速度低且24小时IC-GH低的儿童则有明显的生长加速。
