Van Dop C, Jabs K L, Donohoue P A, Bock G H, Fivush B A, Harmon W E
Division of Pediatric Endocrinology, University of California School of Medicine, Los Angeles.
J Pediatr. 1992 Feb;120(2 Pt 1):244-50. doi: 10.1016/s0022-3476(05)80435-4.
To determine the usefulness of growth hormone treatment among children with renal allografts, we treated nine children with functioning renal transplants who were less than 16 years of age and had poor growth. The nine children, who were aged 12.6 +/- 4.0 years, had (1) heights greater than 2.5 SD less than the mean for age, (2) growth rates less than or equal to 5 cm/yr, and (3) additional growth potential, as assessed by bone age (8.9 +/- 2.8 year). Insulin-like growth factor I, thyrotropin, and thyroid hormone levels were normal for age in all children. Growth hormone treatment increased growth rates from 1.9 +/- 1.1 cm/yr to 7.2 +/- 1.8 cm/yr without accelerating skeletal maturation and without advancing pubertal status. During growth hormone treatment, serum creatinine concentration rose from 140 +/- 50 to 190 +/- 80 mumol/L (1.6 +/- 0.6 to 2.1 +/- 0.9 mg/dl) (p less than 0.05), and creatinine clearances decreased from 0.79 +/- 0.37 to 0.58 +/- 0.30 ml/sec per 1.73 m2 (47 +/- 22 to 35 +/- 18 ml/min per 1.73 m2) (p less than 0.05) but then remained stable. Growth rates of two patients returned to pretreatment rates when growth hormone treatment was discontinued after 5 and 7 months because of increased serum creatinine values. Growth hormone treatment may be useful as adjunctive therapy for increasing growth rates in selected children with renal allografts who have poor growth; however, serum creatinine concentrations should be closely monitored during such treatment.
为了确定生长激素治疗在肾移植儿童中的有效性，我们对9名年龄小于16岁且生长发育不良的肾移植功能良好的儿童进行了治疗。这9名儿童的年龄为12.6±4.0岁，他们（1）身高比同龄人平均身高低2.5个标准差以上，（2）生长速度小于或等于5厘米/年，（3）根据骨龄评估（8.9±2.8岁）有额外的生长潜力。所有儿童的胰岛素样生长因子I、促甲状腺激素和甲状腺激素水平在年龄上均正常。生长激素治疗使生长速度从1.9±1.1厘米/年提高到7.2±1.8厘米/年，而没有加速骨骼成熟，也没有使青春期状态提前。在生长激素治疗期间，血清肌酐浓度从140±50微摩尔/升升至190±80微摩尔/升（1.6±0.6至2.1±0.9毫克/分升）（p<0.05），肌酐清除率从每1.73平方米0.79±0.37毫升/秒降至0.58±0.30毫升/秒（47±22至35±18毫升/分钟每1.73平方米）（p<0.05），但随后保持稳定。由于血清肌酐值升高，两名患者在生长激素治疗5个月和7个月后停药，其生长速度恢复到治疗前水平。生长激素治疗可能作为辅助治疗对选定的生长发育不良的肾移植儿童提高生长速度有用；然而，在这种治疗期间应密切监测血清肌酐浓度。
