Institute of Maternal and Child Research, University of Chile, Santiago, Chile.
Horm Res Paediatr. 2013;79(2):88-96. doi: 10.1159/000347024. Epub 2013 Feb 14.
Glucocorticoid immunosuppressant therapy in pediatric kidney transplant (Tx) recipients does not allow the improvement of growth after Tx.
To determine the effect of early steroid withdrawal (SW) on longitudinal growth, insulin sensitivity (IS), and body composition (BC).
This was a prospective, randomized, multicenter study in Tx. Insulin-like growth factor (IGF)-I, IGF-binding protein 3 (IGFBP3), IS, and BC (DEXA/pQCT) were determined at baseline and up to 12 months after Tx.
A total of 30 patients were examined; 14 patients were assigned to the SW group (7 male, 7 female; 12 in Tanner stage I) and 16 patients were assigned to the steroid control (SC) group (10 male, 6 female;12 in Tanner stage I). Their chronological age was 7.8 ± 4.3 years, height was -2.3 ± 0.99 SD scores (SDS), and body mass index -0.3 ± 1.2 SDS. After 1 year, the SW group showed an increase in height SDS (+1.2 ± 0.22 vs. +0.60 ± 0.13 SDS in the SC group, p < 0.02), lower IGFBP3 (p < 0.05), cholesterol (p < 0.05), and higher high-density lipoprotein cholesterol (p < 0.05). SW patients had lower trunk fat with no differences in IS. Only in prepubertal patients, the SW group had lower glycemia (p < 0.05), very low-density lipoprotein cholesterol (p < 0.01), triglycerides (p < 0.05), triglycerides/glycemia index (TyG; p < 0.02), and better lean mass. Both groups showed an improvement in lean mass after kidney Tx.
SW improved longitudinal growth, lipid profile, and trunk and lean fat in Tx patients. In prepubertal recipients, the decrease in TyG suggests better IS.
糖皮质激素免疫抑制剂治疗在儿科肾移植（Tx）受者中不能改善 Tx 后的生长。
确定早期类固醇停药（SW）对纵向生长、胰岛素敏感性（IS）和身体成分（BC）的影响。
这是一项前瞻性、随机、多中心 Tx 研究。在 Tx 后 12 个月内，测定胰岛素样生长因子（IGF）-I、IGF 结合蛋白 3（IGFBP3）、IS 和 BC（DEXA/pQCT）。
共检查了 30 例患者；14 例患者被分配到 SW 组（7 名男性，7 名女性；12 名 Tanner Ⅰ期），16 例患者被分配到类固醇对照组（SC）组（10 名男性，6 名女性；12 名 Tanner Ⅰ期）。他们的年龄为 7.8±4.3 岁，身高为-2.3±0.99 SD 评分（SDS），体重指数为-0.3±1.2 SDS。1 年后，SW 组身高 SDS 增加（+1.2±0.22 比 SC 组+0.60±0.13 SDS，p<0.02），IGFBP3 降低（p<0.05），胆固醇（p<0.05）和高密度脂蛋白胆固醇升高（p<0.05）。SW 患者的躯干脂肪减少，但 IS 无差异。只有在青春期前患者中，SW 组的血糖（p<0.05）、极低密度脂蛋白胆固醇（p<0.01）、甘油三酯（p<0.05）、甘油三酯/血糖指数（TyG；p<0.02）和更好的瘦体重降低。两组 Tx 后均改善了瘦体重。
SW 改善了 Tx 患者的纵向生长、血脂谱以及躯干和瘦脂肪。在青春期前受者中，TyG 的降低提示 IS 更好。
