Hokken-Koelega A C, Stijnen T, de Muinck Keizer-Schrama S M, Wit J M, Wolff E D, de Jong M C, Donckerwolcke R A, Abbad N C, Bot A, Blum W F
Division of Endocrinology, Sophia Children's Hospital, Rotterdam, The Netherlands.
Lancet. 1991 Sep 7;338(8767):585-90. doi: 10.1016/0140-6736(91)90604-n.
Stunted growth is a serious problem for children with chronic renal failure (CRF) despite normal endogenous growth hormone secretion and normal or elevated plasma concentrations of insulin-like growth factors (IGF) I and II. Biosynthetic growth hormone (GH) was given to 20 prepubertal children (eleven boys, nine girls; mean age 9.5 years, range 4-16) with CRF and severe growth retardation in a placebo-controlled, double-blind, cross-over trial. 6 months of subcutaneous injection of GH (4 IU/m2 per day) was either preceded or followed by 6 months of placebo injection. The patients had a full examination every 3 months. Sixteen children completed the study. Height velocity improved significantly with GH therapy (p less than 0.0001) and placebo (p less than 0.04), but the GH-induced height-velocity increase exceeded that of placebo by 2.9 cm per 6 months. There was a positive relationship between prestudy height velocity and height-velocity increase. Bone maturation was not affected. GH caused a significant increase in IGF-I and a moderate increase in IGF-II plasma concentrations. The pretreatment elevation of IGF-binding protein-1 decreased by almost 50% during GH therapy, while IGF-binding protein-3 increased significantly in concentration, although this increase was significantly smaller than the GH-induced increase in IGF-I. Fructosamine, lipid, and parathyroid concentrations remained constant. Renal function deterioration did not accelerate. Impressive height-velocity increase can be achieved with GH therapy in children with CRF and growth retardation without changes in renal function. Bone maturation appears unaffected suggesting improved final height. Treatment is best started before growth retardation becomes considerable.
对于慢性肾衰竭（CRF）患儿而言，生长发育迟缓是一个严重问题，尽管其体内生长激素分泌正常，胰岛素样生长因子（IGF）I和II的血浆浓度正常或升高。在一项安慰剂对照、双盲、交叉试验中，对20名患有CRF且严重生长发育迟缓的青春期前儿童（11名男孩，9名女孩；平均年龄9.5岁，范围4 - 16岁）给予生物合成生长激素（GH）。皮下注射GH（每天4 IU/m²）6个月，之前或之后给予6个月的安慰剂注射。患者每3个月进行一次全面检查。16名儿童完成了该研究。GH治疗（p < 0.0001）和安慰剂治疗（p < 0.04）后身高增长速度均显著改善，但GH诱导的身高增长速度每6个月比安慰剂组高出2.9 cm。研究前身高增长速度与身高增长速度增加之间存在正相关。骨成熟未受影响。GH导致IGF - I显著增加，IGF - II血浆浓度适度增加。GH治疗期间，IGF结合蛋白 - 1治疗前的升高几乎降低了50%，而IGF结合蛋白 - 3浓度显著增加，尽管这一增加显著小于GH诱导的IGF - I增加。果糖胺、血脂和甲状旁腺浓度保持不变。肾功能恶化未加速。对于患有CRF和生长发育迟缓的儿童，GH治疗可实现显著的身高增长速度增加，且肾功能无变化。骨成熟似乎未受影响，提示最终身高可能改善。最好在生长发育迟缓变得严重之前开始治疗。
