Division of Endocrinology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands.
Eur J Endocrinol. 2010 May;162(5):887-95. doi: 10.1530/EJE-09-1113. Epub 2010 Feb 22.
GnRH analogue (GnRHa) combined with GH treatment has been proposed to increase adult height. Effect on metabolic profile and GH, IGF1, and IGFBP3 levels in short small for gestational age (SGA) children is unknown.
To assess fat mass and lean body mass SDS, percentage trunk fat, blood pressure (BP), insulin sensitivity (Si), beta-cell function (disposition index, DI), lipid profile, and GH, IGF1, and IGFBP3 levels during 2 years of combined treatment.
Forty-one pubertal short SGA children with a mean (+/-S.D.) age of 12.1 (+/-1.0) years.
Children received 3.75 mg of leuprolide acetate depot subcutaneously every 4 weeks, and they were randomly assigned to receive 1 mg (group A) or 2 mg (group B) of GH/m(2) per day.
Percentage trunk fat increased in both groups, but to a lower extent in group B. Lean body mass SDS increased only in group B. Changes in BP, Si, DI, and lipids were similar in both groups. Si significantly decreased, but DI remained unchanged. Lipids remained normal. GH and IGF1 levels were significantly higher in group B.
Our study is the first to report that 2 years of combined treatment with a GnRHa and either 1 or 2 mg GH/m(2) per day does not adversely affect body composition and metabolic profile of short SGA children who come under medical attention at the onset of puberty. There was a dose-dependent effect on fat mass SDS(height), percentage trunk fat, lean body mass SDS(height), and GH and IGF1 levels in favor of treatment with GnRHa and the higher GH dose of 2 mg/m(2) per day.
促性腺激素释放激素类似物（GnRHa）联合生长激素（GH）治疗已被提议用于增加成年身高。但对于生长激素缺乏的矮小身材且胎龄较小（SGA）儿童，该治疗方案对代谢谱和 GH、IGF1 和 IGFBP3 水平的影响尚不清楚。
评估在联合治疗 2 年后，脂肪和瘦体重 SDS、躯干脂肪百分比、血压（BP）、胰岛素敏感性（Si）、β细胞功能（处置指数，DI）、血脂谱以及 GH、IGF1 和 IGFBP3 水平的变化。
41 名青春期矮小 SGA 儿童，平均（+/-S.D.）年龄为 12.1（+/-1.0）岁。
儿童每 4 周接受 3.75 mg 醋酸亮丙瑞林皮下注射，随机分为每天接受 1 mg（A 组）或 2 mg（B 组）的 GH/m2。
两组的躯干脂肪百分比均增加，但 B 组的增加程度较低。B 组的瘦体重 SDS 增加。两组的 BP、Si、DI 和脂质变化相似。Si 显著下降，但 DI 保持不变。血脂仍正常。B 组的 GH 和 IGF1 水平显著升高。
本研究首次报道，在青春期开始时接受医疗关注的矮小 SGA 儿童，联合使用 GnRHa 和每天 1 或 2 mg GH/m2 治疗 2 年，不会对身体成分和代谢谱产生不利影响。在脂肪质量 SDS（身高）、躯干脂肪百分比、瘦体重 SDS（身高）以及 GH 和 IGF1 水平方面，存在剂量依赖性的作用，GnRHa 和每天 2 mg/m2 的较高 GH 剂量更有利。
