Gardner Melissa, Sandberg David E
Department of Pediatrics and Communicable Diseases, Child Behavioral Health, University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
Pediatr Endocrinol Rev. 2011 Dec;9(2):579-88; quiz 589.
The advent of the unlimited availability of recombinant human growth hormone (rhGH) ushered in a new era of clinical management options and decisions for children with short stature, in particular, for those without GH deficiency. Ethical questions about treating non-GH-deficient short-statured children with rhGH quickly arose. After over two decades and after several additional indications for rhGH use in children were approved, many issues remain relevant today, e.g., under what circumstances should rhGH be used; is rhGH a treatment for psychosocial problems; and do benefits outweigh risks? Ideally, findings from large placebo-controlled randomized clinical trials would inform clinical management decisions; however, their conduct has proved infeasible thus far. Still, mounting research evidence has addressed many aspects of the controversies in this area of elective care. Clinicians are encouraged to systematically explore alternative, evidence-based options to rhGH treatment with parents and patients as a remedy for any perceived liabilities of SS, either in the present or future.
重组人生长激素（rhGH）的无限供应开启了矮小儿童临床管理选择和决策的新时代，特别是对于那些没有生长激素缺乏症的儿童。关于使用rhGH治疗非生长激素缺乏型矮小儿童的伦理问题很快就出现了。经过二十多年，以及儿童使用rhGH的其他适应症获批后，许多问题如今仍然存在，例如，在何种情况下应使用rhGH；rhGH是否是治疗心理社会问题的方法；以及益处是否大于风险？理想情况下，大型安慰剂对照随机临床试验的结果将为临床管理决策提供依据；然而，到目前为止，进行此类试验已证明不可行。尽管如此，越来越多的研究证据已经涉及到了这一选择性医疗领域争议的许多方面。鼓励临床医生与家长和患者系统地探索rhGH治疗的替代、基于证据的选择，以弥补矮小症在当前或未来任何被认为的不足之处。
