Smyczyńska Joanna, Lewiński Andrzej, Hilczer Maciej, Stawerska Renata, Karasek Michał
Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital--Research Institute, Łódź.
Endokrynol Pol. 2007 May-Jun;58(3):182-7.
Assessment of growth hormone (GH) secretion is based on stimulation tests. Low GH peaks in stimulation tests, together with decreased insulin-like growth factor-I (IGF-I) secretion, confirm a diagnosis of GH deficiency (GHD). However, limitations in interpreting the test results and discrepancies between GH and IGF-I secretion in particular patients have both been reported. GH therapy should improve the prognosis of adult height (PAH). The aim of the study was to compare the deficit of height at diagnosis, IGF-I secretion and PAH in children with either decreased (in varying degrees of severity) or normal GH secretion in stimulation tests.
The analysis comprised 540 short children (373 boys, 167 girls), aged 11.7 +/- 3.2 years. In all the patients two GH stimulation tests were performed, IGF-I serum concentration was measured, bone age was assessed and PAH was calculated. According to the GH peak in the two stimulation tests, the patients were classified into the following groups: severe GHD (sGHD)--GH peak < 5 ng/mL (n = 44), partial GHD (pGHD)--GH peak 5-10 ng/mL (n = 190), idiopathic short stature (ISS)--GH peak at least 10 ng/mL (n = 306).
A significantly greater deficit of height, lower IGF-I secretion and worse PAH were observed in sGHD than in both remaining groups, while all the differences between pGHD and ISS in the parameters analysed were insignificant.
The results obtained indicate the necessity of applying another methods of qualifying short children for GH therapy other than GH stimulation tests with a cut-off value at a level of 10 ng/mL.
生长激素（GH）分泌的评估基于刺激试验。刺激试验中GH峰值较低，同时胰岛素样生长因子-I（IGF-I）分泌减少，可确诊生长激素缺乏症（GHD）。然而，已有报道称在解释试验结果方面存在局限性，特别是某些患者的GH与IGF-I分泌之间存在差异。GH治疗应能改善成人身高预后（PAH）。本研究的目的是比较刺激试验中GH分泌减少（程度不同）或正常的儿童在诊断时的身高缺陷、IGF-I分泌和PAH。
分析包括540名身材矮小的儿童（373名男孩，167名女孩），年龄为11.7±3.2岁。对所有患者进行了两次GH刺激试验，测量了血清IGF-I浓度，评估了骨龄并计算了PAH。根据两次刺激试验中的GH峰值，将患者分为以下几组：严重GHD（sGHD）——GH峰值<5 ng/mL（n = 44），部分GHD（pGHD）——GH峰值5 - 10 ng/mL（n = 190），特发性身材矮小（ISS）——GH峰值至少10 ng/mL（n = 306）。
与其余两组相比，sGHD患者的身高缺陷明显更大、IGF-I分泌更低且PAH更差，而pGHD和ISS在分析参数上的所有差异均无统计学意义。
所得结果表明，除了以10 ng/mL为临界值的GH刺激试验外，有必要采用其他方法来确定身材矮小儿童是否适合GH治疗。
