Department of Pediatrics, Chang Gung Memorial Hospital, Chung Gung University College of Medicine, Taoyuan, Taiwan.
J Formos Med Assoc. 2012 Jul;111(7):355-63. doi: 10.1016/j.jfma.2011.06.011. Epub 2012 May 23.
BACKGROUND/PURPOSE: Human growth hormone (GH) has been successfully used in children with GH deficiency (GHD). However, there are few published data on the effect of GH in Taiwanese children with GHD.
We performed a retrospective cohort study to identify factors influencing the effect of GH therapy on ethnic Chinese children with GHD in Taiwan. Idiopathic GHD can be classified into isolated GHD (IGHD) and multiple pituitary hormone deficiency (MPHD). The study looked at the effect of GH on the auxological, biochemical, and imaging parameters of 51 patients (13 girls and 38 boys) in three different diagnostic groups: MPHD (n = 12), IGHD (n = 8), and transient GHD (TGHD; n = 31). TGHD is defined as a GH peak >10 μg/L in re-evaluation by two GH stimulation tests approximately 6 months after discontinuation of GH therapy.
The height velocity for first-year GH therapy was 7.61 ± 1.46, 8.14 ± 1.92, and 9.99 ± 2.75 cm/y in the TGHD, IGHD, and MPHD groups, respectively. After post hoc comparison, the MPHD group had a significantly accelerated height velocity in the first year compared to the TGHD group. Correlation analysis showed that a change in height standard deviation score (SDS) in the first year had a significant negative correlation with the following variables: peak GH (r = -0.52, p < 0.001), pretreatment height SDS (r = -0.49, p < 0.001), and height-target height (Ht-TH) SDS (r = -0.49, p < 0.001). Change in height SDS in the first 2 years had a significantly negative correlation with peak GH (r = -0.51, p < 0.001), insulin-like growth factor-1 SDS (r = -0.35, p = 0.022), height SDS (r = -0.60, p < 0.001), difference between bone age and chronological age (r = -0.46, p = 0.001), and Ht-TH SDS (r = -0.50, p = 0.001). After using multiple linear regression, the pretreatment GH peak value was found to be significantly associated with height increments after 1 year of GH treatment (B = -0.07, p = 0.014).
The administration of GH to children with GHD results in a pronounced acceleration in linear growth during the first year of treatment, especially in those with MPHD. The diagnosis of GHD requires comprehensive auxological, biochemical, and brain magnetic resonance imaging assessment. We also suggest that patients with GHD, specifically IGHD, must undergo a re-evaluation of GH secretion after completion of GH therapy.
背景/目的：人体生长激素（GH）已成功用于治疗生长激素缺乏症（GHD）患儿。然而，关于生长激素治疗对台湾地区 GHD 患儿的影响，仅有少量文献报道。
我们进行了一项回顾性队列研究，以确定影响生长激素治疗对台湾地区 GHD 汉族儿童疗效的因素。特发性 GHD 可分为孤立性 GHD（IGHD）和多种垂体激素缺乏症（MPHD）。本研究观察了生长激素对 51 名患儿（13 名女孩和 38 名男孩）的生长发育、生化和影像学参数的影响，这些患儿分为三个不同的诊断组：MPHD（n=12）、IGHD（n=8）和短暂性 GHD（TGHD；n=31）。TGHD 定义为在停止生长激素治疗约 6 个月后，通过两项生长激素刺激试验，GH 峰值>10μg/L。
TGHD、IGHD 和 MPHD 组患儿第一年生长激素治疗的身高速度分别为 7.61±1.46、8.14±1.92 和 9.99±2.75cm/y。事后比较显示，MPHD 组患儿在第一年的身高增速明显快于 TGHD 组。相关性分析显示，第一年身高标准差评分（SDS）的变化与以下变量显著负相关：GH 峰值（r=-0.52，p<0.001）、治疗前身高 SDS（r=-0.49，p<0.001）和身高-目标身高（Ht-TH）SDS（r=-0.49，p<0.001）。第一年和第二年身高 SDS 的变化与 GH 峰值（r=-0.51，p<0.001）、胰岛素样生长因子-1 SDS（r=-0.35，p=0.022）、身高 SDS（r=-0.60，p<0.001）、骨龄与实际年龄之差（r=-0.46，p=0.001）和 Ht-TH SDS（r=-0.50，p=0.001）显著负相关。使用多元线性回归后，发现治疗前 GH 峰值与生长激素治疗 1 年后的身高增长显著相关（B=-0.07，p=0.014）。
生长激素治疗 GHD 患儿可显著加速第一年的线性生长，尤其是 MPHD 患儿。GHD 的诊断需要全面的生长发育、生化和脑磁共振成像评估。我们还建议 GHD 患者，特别是 IGHD 患者，在完成生长激素治疗后必须重新评估 GH 分泌情况。
