Renes J S, Willemsen R H, Mulder J C, Bakker-van Waarde W M, Rotteveel J, Oostdijk W, Houdijk E C A M, Westerlaken C, Noordam C, Verrijn Stuart A A, Odink R J, de Ridder M A J, Hokken-Koelega A C S
Department of Pediatrics, Division of Endocrinology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands.
Clin Endocrinol (Oxf). 2015 Jun;82(6):854-61. doi: 10.1111/cen.12677. Epub 2015 Feb 9.
Growth hormone (GH) treatment is effective in improving adult height (AH) in short children born SGA. However, there is a wide variation in height gain, even after adjustment for predictive variables. It is therefore important to investigate new factors which can influence the response to GH.
To investigate the efficacy of GH treatment (1 mg/m(2/) day) in short SGA children on AH. To assess the relation between spontaneous catch-up growth after birth and growth during puberty on the total height gain SDS to AH.
Longitudinal GH trial in 170 children.
Median age at start of GH was 7·1 years and height -3·0 SDS. AH was -1·8 SDS (TH-corrected AH -1·1 SDS) in boys and -1·9 SDS (TH-corrected AH -1·3 SDS) in girls. Spontaneous catch-up growth after birth was ≥0·5 SDS in 42% of children. In contrast to expectation, spontaneous catch-up growth was negatively correlated with total height gain SDS during GH (P = 0·009). During puberty, height SDS declined (-0·4 SDS in boys and -0·5 SDS in girls) resulting in a lower total height gain SDS than expected. Pubertal height gain was 25·5 cm in boys and 15·3 cm in girls, significantly lower compared to AGA children (P < 0·001). At onset of puberty, BA for boys and girls was moderately advanced (P = 0·02 and P < 0·001, respectively). Growth velocity was comparable to AGA children during the first two years of puberty, but thereafter significantly lower until reaching AH (P < 0·001).
In contrast to our hypothesis, children with greater spontaneous catch-up growth after birth show a lower total height gain SDS during GH. Height SDS declines from mid-puberty, due to a marked early deceleration of growth velocity.
生长激素（GH）治疗对改善小于胎龄儿（SGA）出生的矮小儿童的成人身高（AH）有效。然而，即使对预测变量进行了校正，身高增长仍存在很大差异。因此，研究可能影响GH反应的新因素很重要。
研究GH治疗（1mg/m²/天）对SGA矮小儿童AH的疗效。评估出生后自发追赶生长与青春期生长对AH总身高增长标准差分值（SDS）的关系。
对170名儿童进行纵向GH试验。
开始GH治疗的中位年龄为7.1岁，身高为-3.0 SDS。男孩的AH为-1.8 SDS（经TH校正的AH为-1.1 SDS），女孩为-1.9 SDS（经TH校正的AH为-1.3 SDS）。42%的儿童出生后自发追赶生长≥0.5 SDS。与预期相反，出生后自发追赶生长与GH治疗期间总身高增长SDS呈负相关（P = 0.009）。青春期期间，身高SDS下降（男孩为-0.4 SDS，女孩为-0.5 SDS），导致总身高增长SDS低于预期。男孩青春期身高增长为25.5 cm，女孩为15.3 cm，明显低于适于胎龄儿（AGA）儿童（P < 0.001）。青春期开始时，男孩和女孩的骨龄（BA）中度提前（分别为P = 0.02和P < 0.001）。青春期前两年的生长速度与AGA儿童相当，但此后显著降低，直至达到AH（P < 0.001）。
与我们的假设相反，出生后自发追赶生长较多的儿童在GH治疗期间总身高增长SDS较低。由于生长速度在青春期中期明显早期减速，身高SDS从青春期中期开始下降。
