Esen Ihsan, Demirel Fatma, Tepe Derya, Kara Ozlem, Koc Nevra
Department of Pediatric Endocrinology, Ankara Child's Diseases and Hematology Oncology Hospital, Ankara, Turkey.
Growth Horm IGF Res. 2013 Oct;23(5):196-9. doi: 10.1016/j.ghir.2013.07.001. Epub 2013 Jul 23.
We wanted to examine the relationship between initial growth response to recombinant human Growth Hormone (rhGH) treatment and body composition in children with growth hormone deficiency (GHD).
Forty-two patients (21 boys and 21 girls) aged between 5.7-15.5 years (mean age: 10.8 ± 2.6 years) with isolated GHD. The auxological and laboratory data (GH and IGF-I levels) and results of bioelectrical impedance analyses were evaluated. Children with GHD were followed up for 12 months and categorized according to growth response to rhGH into good and poor responders (change in height of > 0.7 SDS or < 0.7 SDS over one year respectively). Mean doses of rhGH per kg of fat free mass (FFM) were calculated.
Forty-eight percent of patients showed a good growth response to rhGH therapy. At study entry, mean age, height SDS, weight SDS, serum IGF-1 SDS, IGFBP-3 SDS, growth velocity prior to rhGH therapy, GH after clonidine and l-dopa were similar in the two groups. At baseline, BMI SDS and waist-hip ratio were significantly higher in good responders (p = 0.02 and p = 0.006, respectively). Good responders had lower percentages of FFM (73.4 ± 8.9 vs. 83.1 ± 5.9) and total body water (TBW) (56.5 ± 5.3 vs. 63.1 ± 4.4), compared to poor responders (p < 0.05). There were significant correlations between changes in height SDS over one year and baseline body composition in children with GHD on rhGH treatment (r = -0.617 for percentage of FFM, r = -0.629 for percentage of TBW, p < 0.001). A correlation between BMI SDS, waist-hip ratio, mean rhGH dose per FFM and growth response was observed only in prepubertal subjects.
Baseline body composition data in children with GHD can be used to predict the growth response to rhGH treatment. A management strategy that involves titrating rhGH dose according to FFM as a means of optimizing the growth response to intervention requires further study.
我们想要研究生长激素缺乏症（GHD）患儿对重组人生长激素（rhGH）治疗的初始生长反应与身体成分之间的关系。
42例年龄在5.7至15.5岁（平均年龄：10.8±2.6岁）的孤立性GHD患儿（21名男孩和21名女孩）。评估了人体测量学和实验室数据（GH和IGF-I水平）以及生物电阻抗分析结果。对GHD患儿进行了12个月的随访，并根据对rhGH的生长反应分为反应良好者和反应不佳者（分别为一年内身高变化>0.7 SDS或<0.7 SDS）。计算了每千克去脂体重（FFM）的rhGH平均剂量。
48%的患者对rhGH治疗表现出良好的生长反应。在研究开始时，两组的平均年龄、身高SDS、体重SDS、血清IGF-1 SDS、IGFBP-3 SDS、rhGH治疗前的生长速度、可乐定和左旋多巴后的GH相似。在基线时，反应良好者的BMI SDS和腰臀比显著更高（分别为p = 0.02和p = 0.006）。与反应不佳者相比，反应良好者的FFM百分比（73.4±8.9对83.1±5.9）和总体水（TBW）百分比（56.5±5.3对63.1±4.4）更低（p<0.05）。接受rhGH治疗的GHD患儿一年内身高SDS的变化与基线身体成分之间存在显著相关性（FFM百分比r = -0.617，TBW百分比r = -0.629，p<0.001）。仅在青春期前受试者中观察到BMI SDS、腰臀比、每FFM的rhGH平均剂量与生长反应之间的相关性。
GHD患儿的基线身体成分数据可用于预测对rhGH治疗的生长反应。一种根据FFM调整rhGH剂量以优化干预生长反应的管理策略需要进一步研究。
