生长激素治疗结束后特发性身材矮小成年患者的骨密度：一项 5 年的纵向研究。
Bone Mineral Density After Cessation of GH Treatment in Young Adults Born SGA: A 5-Year Longitudinal Study.
机构信息
Department of Paediatrics, Subdivision Endocrinology, Erasmus University Medical Center, 3015CN Rotterdam, Netherlands.
Dutch Growth Research Foundation, 3016AH Rotterdam, Netherlands.
出版信息
J Clin Endocrinol Metab. 2017 Sep 1;102(9):3508-3516. doi: 10.1210/jc.2017-00269.
CONTEXT
Short children born small for gestational age (SGA) have below-average bone mineral density (BMD). Growth hormone (GH) treatment improves height and BMD in short SGA children. Longitudinal data on BMD in adults born SGA, after GH cessation (GH-stop), are lacking.
OBJECTIVE
To determine BMD in young adults born SGA during 5 years after GH-stop.
METHODS
In 173 GH-treated adults born SGA (SGA-GH), BMD of total body (BMDTB) and bone mineral apparent density of lumbar spine (BMADLS) were measured longitudinally at adult height (AH) and 6 months, 2 years, and 5 years thereafter. At 5 years after GH-stop (age 21 years), data were compared with 45 untreated short SGA adults (SGA-S), 59 SGA adults with spontaneous catch-up (SGA-CU), and 81 adults born appropriate for gestational age (AGA).
RESULTS
At GH-stop (mean age 16.4 years), estimated mean (standard error) BMDTB standard deviation score (SDS) was -0.40 (0.1) in males and -0.51 (0.1) in females, followed by a trend toward a decrease of BMDTB in males to -0.59 (0.1) at 5 years after GH-stop (P = 0.06), whereas it remained stable in females [-0.57 (0.1); P = 0.33]. At GH-stop, BMADLS SDS was -0.01 (0.1) in males and -0.29 (0.1) in females, followed by a decrease in males and females to -0.38 and -0.55, respectively, at 5 years after GH-stop (P < 0.001). At 5 years after GH-stop, BMDTB and BMADLS in SGA-GH were similar compared with SGA-S, SGA-CU, and AGA.
CONCLUSION
After GH-stop, there is a gradual decline of BMADLS, but at the age of 21 years, BMDTB and BMADLS are similar as in untreated short SGA adults.
背景
出生时为小于胎龄儿（SGA）且身材矮小的儿童骨矿物质密度（BMD）低于平均水平。生长激素（GH）治疗可改善身材矮小的 SGA 儿童的身高和 BMD。缺乏关于 GH 停止（GH-stop）后 SGA 出生的成年人 BMD 的纵向数据。
目的
确定 GH 治疗的 SGA 出生成年人在 GH 停止后 5 年内的 BMD。
方法
对 173 名 GH 治疗的 SGA 出生成年人（SGA-GH）进行了纵向研究，在成人身高（AH）和此后的 6 个月、2 年和 5 年测量了全身 BMD（BMDTB）和腰椎骨矿物质表观密度（BMADLS）。在 GH 停止后 5 年（21 岁）时，将数据与 45 名未经治疗的身材矮小的 SGA 成年人（SGA-S）、59 名自发追赶生长的 SGA 成年人（SGA-CU）和 81 名胎龄合适的成年人（AGA）进行了比较。
结果
在 GH 停止时（平均年龄 16.4 岁），男性的估计平均（标准误差）BMDTB 标准差评分（SDS）为-0.40（0.1），女性为-0.51（0.1），随后男性的 BMDTB 呈下降趋势，在 GH 停止后 5 年时降至-0.59（0.1）（P = 0.06），而女性则保持稳定[-0.57（0.1）；P = 0.33]。在 GH 停止时，男性的 BMADLS SDS 为-0.01（0.1），女性为-0.29（0.1），随后男性和女性分别下降至-0.38 和-0.55，在 GH 停止后 5 年（P < 0.001）。在 GH 停止后 5 年，SGA-GH 的 BMDTB 和 BMADLS 与 SGA-S、SGA-CU 和 AGA 相似。
结论
GH 停止后，BMADLS 逐渐下降，但在 21 岁时，BMDTB 和 BMADLS 与未经治疗的身材矮小的 SGA 成年人相似。
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