Grimberg Adda, Allen David B
aDepartment of Pediatrics, Perelman School of Medicine, University of Pennsylvania bDivision of Endocrinology and Diabetes, The Children's Hospital of Philadelphia cLeonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania dDepartment of Pediatrics, University of Wisconsin School of Medicine and Public Health eDivision of Endocrinology and Diabetes, American Family Children's Hospital, Madison, Wisconsin, USA.
Curr Opin Pediatr. 2017 Aug;29(4):466-471. doi: 10.1097/MOP.0000000000000505.
The Pediatric Endocrine Society recently published new guidelines for the use of human growth hormone (hGH) and human insulin-like growth factor-I (hIGF-I) treatment for growth hormone deficiency, idiopathic short stature, and primary IGF-I deficiency in children and adolescents. This review places the new guidelines in historical contexts of the life cycle of hGH and the evolution of US health care, and highlights their future implications.
The new hGH guidelines, the first to be created by the Grading of Recommendations Assessment, Development and Evaluation approach, are more conservative than their predecessors. They follow an extended period of hGH therapeutic expansion at a time when US health care is pivoting toward value-based practice. There are strong supporting evidence and general agreement regarding the restoration of hormonal normalcy in children with severe deficiency of growth hormone or hIGF-I. More complex are issues related to hGH treatment to increase growth rates and heights of otherwise healthy short children with either idiopathic short stature or 'partial' isolated idiopathic growth hormone deficiency.
The guidelines-developing process revealed fundamental questions about hGH treatment that still need evidence-based answers. Unless and until such research is performed, a more restrained hGH-prescribing approach is appropriate.
美国儿科学会内分泌学会最近发布了关于使用人生长激素（hGH）和人胰岛素样生长因子-I（hIGF-I）治疗儿童及青少年生长激素缺乏症、特发性身材矮小和原发性IGF-I缺乏症的新指南。本综述将新指南置于hGH生命周期的历史背景以及美国医疗保健的演变之中，并强调其未来影响。
新的hGH指南是采用推荐分级评估、制定和评价方法制定的首个此类指南，比其前任指南更为保守。在美国医疗保健正转向基于价值的实践之际，它们是在hGH治疗扩展的较长时期之后发布的。对于严重生长激素或hIGF-I缺乏儿童恢复激素正常水平，有强有力的支持证据和普遍共识。与hGH治疗以提高特发性身材矮小或“部分”孤立性特发性生长激素缺乏的健康矮小儿童的生长速度和身高相关的问题则更为复杂。
指南制定过程揭示了关于hGH治疗的一些基本问题，这些问题仍需要基于证据的答案。除非进行此类研究，否则更谨慎的hGH处方方法是合适的。
