Aurensanz Clemente Esther, Samper Villagrasa Pilar, Ayerza Casas Ariadna, Ruiz Frontera Pablo, Bueno Lozano Olga, Moreno Aznar Luis Alberto, Bueno Lozano Gloria
Departamento de Pediatría, Hospital de Barbastro, Barbastro, Huesca, España.
Departamento de Pediatría, Hospital Clínico Universitario de Zaragoza, Zaragoza, España.
An Pediatr (Barc). 2017 May;86(5):240-248. doi: 10.1016/j.anpedi.2016.05.001. Epub 2016 Jun 4.
Small for gestational age (SGA) children without catch-up growth can benefit from treatment with growth hormone (rhGH). However, they should be monitored very closely because they are at increased risk of metabolic syndrome.
A group of 28 SGA children with a mean age of 8.79 years and undergoing treatment with rhGH were selected for evaluation. Over the course of 4 years, an annual evaluation was performed on the anthropometric variables (weight, height, body mass index [BMI], growth rate, blood pressure and waist perimeter), metabolic risk variables (glycaemia, glycosylated haemoglobin, cholesterol ratio, insulinaemia, insulin-like growth factor 1[IGF1], IGF binding protein-3 [IGFBP-3], IGF1/IGFBP3 ratio, and HOMA index), and body composition variables.
Treatment with rhGH was associated with a significant increase in height (-2.76±.11 SD to -1.53±.17 SD, P=.000), weight (-1.50±.09 SD to -1.21±.13 SD; P=.016), and growth rate (-1.43±.35 SD to .41±.41 SD; P=.009), without a corresponding change in the BMI. Insulinaemia (9.33±1.93mU/ml to 16.55±1.72mU/ml; P=.044) and the HOMA index (3.63±.76 to 6.43±.67; P=.042) increased, approaching insulin resistance levels. No changes were observed in the lipid profile. Body composition changes were observed, with a significant increase in lean mass (73.19±1.26 to 78.74±1.31; P=.037), and a reduction of fat mass (26.81±1.26 to 21.26±1.31; P=.021).
Treatment with rhGH is effective for improving anthropometric variables in SGA patients who have not experienced a catch-up growth. It also produces changes in body composition, which may lead to a reduction in risk of metabolic syndrome. However, some insulin resistance was observed. It is important to follow up this patient group in order to find out whether these changes persist into adulthood.
小于胎龄（SGA）且无追赶生长的儿童可从生长激素（rhGH）治疗中获益。然而，由于他们患代谢综合征的风险增加，因此应对其进行密切监测。
选取一组平均年龄为8.79岁且正在接受rhGH治疗的28名SGA儿童进行评估。在4年的时间里，对人体测量学变量（体重、身高、体重指数[BMI]、生长速率、血压和腰围）、代谢风险变量（血糖、糖化血红蛋白、胆固醇比值、胰岛素血症、胰岛素样生长因子1[IGF1]、IGF结合蛋白-3[IGFBP-3]、IGF1/IGFBP3比值和HOMA指数）以及身体成分变量进行年度评估。
rhGH治疗与身高显著增加相关（从-2.76±.11标准差增至-1.53±.17标准差，P =.000）、体重增加（从-1.50±.09标准差增至-1.21±.13标准差；P =.016）以及生长速率增加（从-1.43±.35标准差增至.41±.41标准差；P =.009），而BMI无相应变化。胰岛素血症（从9.33±1.93mU/ml增至16.55±1.72mU/ml；P =.044）和HOMA指数（从3.63±.76增至6.43±.67；P =.042）增加，接近胰岛素抵抗水平。血脂谱未观察到变化。观察到身体成分发生改变，瘦体重显著增加（从73.19±1.26增至78.74±1.31；P =.037），脂肪量减少（从26.81±1.26减至21.26±1.31；P =.021）。
rhGH治疗对于改善未经历追赶生长的SGA患者的人体测量学变量有效。它还会引起身体成分的变化，这可能会降低代谢综合征的风险。然而，观察到了一些胰岛素抵抗现象。对该患者群体进行随访以了解这些变化是否会持续至成年很重要。
