儿童生长激素缺乏症的当前诊断和治疗实践：来自土耳其的一项调查
Current practice in diagnosis and treatment of growth hormone deficiency in childhood: a survey from Turkey.
作者信息
Poyrazoğlu Şükran, Akçay Teoman, Arslanoğlu İlknur, Atabek Mehmet Emre, Atay Zeynep, Berberoğlu Merih, Bereket Abdullah, Bideci Aysun, Bircan İffet, Böber Ece, Can Şule, Cesur Yaşar, Darcan Şükran, Demir Korcan, Dündar Bumin, Ersoy Betül, Esen İhsan, Güven Ayla, Kara Cengiz, Keskin Mehmet, Kurtoğlu Selim, Memioğlu Nihal, Özbek Mehmet Nuri, Özgen Tolga, Sarı Erkan, Şıklar Zeynep, Şimşek Enver, Turan Serap, Yeşilkaya Ediz, Yüksel Bilgin, Darendeliler Feyza
机构信息
İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey. Phone: +90 414 20 00/31645 E-mail:
出版信息
J Clin Res Pediatr Endocrinol. 2015 Mar;7(1):37-44. doi: 10.4274/jcrpe.1794.
OBJECTIVE
Approaches to diagnosis and treatment of growth hormone deficiency (GHD) in children vary among countries and even among centers in the same country. This survey, aiming to facilitate the process of preparing the new consensus on GHD by the Turkish Pediatric Endocrinology and Diabetes Society, was designed to evaluate the current practices in diagnosis and treatment of GHD in different centers in Turkey.
METHODS
A questionnaire covering relevant items for diagnosis and treatment of GHD was sent out to all pediatric endocrinology centers.
RESULTS
Twenty-four centers returned the questionnaire. The most frequently used GH stimulation test was L-dopa, followed by clonidine. Eighteen centers used a GH cut-off value of 10 ng/mL for the diagnosis of GHD; this value was 7 ng/mL in 4 centers and 5 ng/mL in 2 centers. The most frequently used assay was immunochemiluminescence for determination of GH, insulin-like growth factor-1 and insulin-like growth factor binding protein-3 concentrations. Sex steroid priming in both sexes was used by 19 centers. The most frequently used starting dose of recombinant human GH (rhGH) in prepubertal children was 0.025-0.030 mg/kg/day and 0.030-0.035 mg/kg/day in pubertal children. Growth velocity was used in the evaluation for growth response to rhGH therapy in all centers. Anthropometric measurements of patients every 3-6 months, fasting blood glucose, bone age and thyroid panel evaluation were used by all centers at follow-up. Main indications for cessation of therapy were decreased height velocity and advanced bone age. Fourteen centers used combined treatment (rhGH and gonadotropin-releasing analogues) to increase final height.
CONCLUSION
Although conformity was found among centers in Turkey in current practice, it is very important to update guideline statements and to modify, if needed, the approach to GHD over time in accordance with new evidence-based clinical studies.
目的
儿童生长激素缺乏症（GHD）的诊断和治疗方法在不同国家甚至同一国家的不同中心之间存在差异。这项调查旨在评估土耳其不同中心GHD诊断和治疗的当前实践情况，以促进土耳其儿科内分泌与糖尿病学会制定关于GHD的新共识。
方法
向所有儿科内分泌中心发送了一份涵盖GHD诊断和治疗相关项目的问卷。
结果
24个中心返回了问卷。最常用的生长激素刺激试验是左旋多巴，其次是可乐定。18个中心使用10 ng/mL的生长激素临界值诊断GHD；4个中心该值为7 ng/mL，2个中心为5 ng/mL。测定生长激素、胰岛素样生长因子-1和胰岛素样生长因子结合蛋白-3浓度最常用的检测方法是免疫化学发光法。19个中心对两性均采用性类固醇激发试验。青春期前儿童重组人生长激素（rhGH）最常用的起始剂量为0.025 - 0.030 mg/kg/天，青春期儿童为0.030 - 0.035 mg/kg/天。所有中心在评估rhGH治疗的生长反应时均使用生长速度。随访时所有中心均对患者每3 - 6个月进行人体测量、空腹血糖、骨龄和甲状腺功能检查评估。治疗停止的主要指征是身高增长速度下降和骨龄提前。14个中心采用联合治疗（rhGH和促性腺激素释放类似物）以增加最终身高。
结论
尽管土耳其各中心在当前实践中存在一致性，但根据新的循证临床研究及时更新指南声明并在必要时修改GHD的治疗方法非常重要。
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