Department of Women's and Children's Health, Karolinska Institute and University Hospital, Stockholm, Sweden.
Horm Res Paediatr. 2011;75(5):335-45. doi: 10.1159/000322878. Epub 2011 Jan 12.
How to define poor growth response in the management of short growth hormone (GH)-treated children is controversial.
Assess various criteria of poor response.
Short GH-treated prepubertal children [n = 456; height (Ht) SD score (SDS) ≤-2] with idiopathic GH deficiency (IGHD, n = 173), idiopathic short stature (ISS, n = 37), small for gestational age (SGA, n = 54), organic GHD (OGHD, n = 40), Turner syndrome (TS, n = 43), skeletal dysplasia (n = 15), other diseases (n = 46) or syndromes (n = 48) were evaluated in this retrospective multicenter study. Median age at GH start was 6.3 years and Ht SDS -3.2.
Median [25-75 percentile] first-year gain in Ht SDS was 0.65 (0.40-0.90) and height velocity (HtV) 8.67 (7.51-9.90) cm/year. Almost 50% of IGHD children fulfilled at least one criterion for poor responders. In 28% of IGHD children, Ht SDS gain was <0.5 and they had lower increases in median IGF-I SDS than those with Ht SDS >0.5. Only IGHD patients with peak stimulated growth hormone level <3 μg/l responded better than those with ISS. A higher proportion of children with TS, skeletal dysplasia or born SGA had Ht SDS gain <0.5.
Many children respond poorly to GH therapy. Recommendations defining a criterion may help in managing short stature patients.
在生长激素（GH）治疗的矮小儿童管理中，如何定义生长反应不良存在争议。
评估生长反应不良的各种标准。
本回顾性多中心研究纳入了 173 例特发性生长激素缺乏症（IGHD）、37 例特发性身材矮小症（ISS）、54 例小于胎龄儿（SGA）、40 例器质性生长激素缺乏症（OGHD）、43 例特纳综合征（TS）、15 例骨骼发育不良、46 例其他疾病或 48 例综合征的 GH 治疗的青春期前矮小儿童（身高标准差评分（Ht SDS）≤-2）。GH 起始时的中位年龄为 6.3 岁，Ht SDS 为-3.2。
中位（25-75 百分位数）第一年 Ht SDS 增加为 0.65（0.40-0.90），身高速度（HtV）为 8.67（7.51-9.90）cm/年。几乎 50%的 IGHD 儿童至少符合一个生长反应不良的标准。在 28%的 IGHD 儿童中，Ht SDS 增加<0.5，且 IGF-I SDS 的中位数增加低于 Ht SDS>0.5 的儿童。仅 IGHD 患者的峰值刺激生长激素水平<3μg/l 者比 ISS 患者的反应更好。TS、骨骼发育不良或出生 SGA 的儿童中，Ht SDS 增加<0.5 的比例较高。
许多儿童对 GH 治疗反应不佳。定义标准的建议可能有助于管理矮小症患者。
