Reinehr T, Bechtold-Dalla Pozza S, Bettendorf M, Doerr H-G, Gohlke B, Hauffa B P, Kaspers S, Land C, Mehls O, Schwab K-O, Stahnke N, Ranke M B
Vestische Hospital for Children and Adolescents, Datteln, University of Witten/Herdecke, Germany.
Exp Clin Endocrinol Diabetes. 2011 Oct;119(9):544-8. doi: 10.1055/s-0031-1285913. Epub 2011 Oct 17.
We hypothesized that overweight children with growth hormone deficiency (GHD) demonstrate a lower response to growth hormone (GH) as a result of a misclassification since obesity is associated with lower GH peaks in stimulation tests.
Anthropometric data, response, and responsiveness to GH in the first year of treatment were compared in 1.712 prepubertal children with GHD from the German KIGS database according to BMI (underweight=group A, normal weight=group B, overweight=group C) (median age: group A, B, C: 7.3, 7.28, and 8.4 years).
Maximum GH levels to tests (median: group A, B, C: 5.8, 5.8, and 4.0 µg/ml) were significantly lower in group C. IGF-I SDS levels were not different between the groups. Growth velocity in the first year of GH treatment was significantly lower in the underweight cohort (median: group A, B, C: 8.2, 8.8, and 9.0 cm/yr), while the gain in height was not different between groups. The difference between observed and predicted growth velocity expressed as Studentized residuals was not significantly different between groups. Separating the 164 overweight children into obese children (BMI>97th centile; n=71) and moderate overweight children (BMI>90th to 97th centile, n=93) demonstrated no significant difference in any parameter.
Overweight prepubertal children with idiopathic GHD demonstrated similar levels of responsiveness to GH treatment compared to normal weight children. Furthermore, the IGF-I levels were low in overweight children. Therefore, a misclassification of GHD in overweight prepubertal children within the KIGS database seems unlikely. The first year growth prediction models can be applied to overweight and obese GHD children.
我们推测，由于肥胖与刺激试验中较低的生长激素（GH）峰值相关，生长激素缺乏症（GHD）的超重儿童对生长激素（GH）的反应较低，这是一种错误分类的结果。
根据体重指数（体重过轻=A组，正常体重=B组，超重=C组）（中位年龄：A组、B组、C组分别为7.3岁、7.28岁和8.4岁），对来自德国KIGS数据库的1712名青春期前GHD儿童治疗第一年的人体测量数据、对GH的反应及反应性进行比较。
C组试验中的最大GH水平（中位值：A组、B组、C组分别为5.8、5.8和4.0μg/ml）显著较低。各组间胰岛素样生长因子-I标准差分值（IGF-I SDS）水平无差异。GH治疗第一年的生长速度在体重过轻队列中显著较低（中位值：A组、B组、C组分别为8.2、8.8和9.0厘米/年），而身高增加在各组间无差异。以学生化残差表示的观察到的生长速度与预测生长速度之间的差异在各组间无显著差异。将164名超重儿童分为肥胖儿童（BMI>第97百分位数；n=71）和中度超重儿童（BMI>第90至97百分位数，n=93），在任何参数上均无显著差异。
特发性GHD的青春期前超重儿童与正常体重儿童相比，对GH治疗的反应水平相似。此外超重儿童的IGF-I水平较低。因此，KIGS数据库中青春期前超重儿童的GHD错误分类似乎不太可能。第一年生长预测模型可应用于超重和肥胖的GHD儿童。
