Witkowska-Sędek Ewelina, Stelmaszczyk-Emmel Anna, Majcher Anna, Demkow Urszula, Pyrżak Beata
Department of Paediatrics and Endocrinology, Medical University of Warsaw, Warszawa, Poland.
Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warszawa, Poland.
Acta Biochim Pol. 2018;65(2):269-275. doi: 10.18388/abp.2017_2541. Epub 2018 Apr 13.
The relationships between bone turnover, the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis and vitamin D are complex, but still not fully explained. The GH/IGF-1 axis and vitamin D can mutually modulate each other's metabolism and influence the activation of cell proliferation, maturation, and mineralization as well as bone resorption. The aim of this study was to evaluate the reciprocal associations between bone formation markers [alkaline phosphatase (ALP), bone alkaline phosphatase (BALP)], the GH/IGF-1 axis and 25-hydroxyvitamin D [25(OH)D] in children with growth hormone deficiency at baseline and during recombinant human growth hormone (rhGH) therapy. ALP, BALP, 25(OH)D and IGF-1 levels were evaluated in 53 patients included in this prospective three-year study. ALP, BALP and IGF-1 increased during rhGH therapy. Baseline ALP activity correlated positively with baseline height velocity (HV). ALP and BALP activity at 12 months correlated positively with HV in the first year of therapy. We found positive correlations between ALP and IGF-1 at baseline and during the first year of therapy, between BALP activity at 12 months and rhGH dose in the first year of therapy, and between doses of cholecalciferol in the first year of rhGH therapy and early changes in BALP activity during rhGH therapy. Our results indicate that vitamin D supplementation enhances the effect of rhGH on bone formation process, which could improve the effects of rhGH therapy. ALP and BALP activity are useful in the early prediction of the effects of rhGH therapy, but their utility as long-term predictors seemed insufficient.
骨转换、生长激素/胰岛素样生长因子-1（GH/IGF-1）轴与维生素D之间的关系较为复杂，但仍未完全阐明。GH/IGF-1轴与维生素D可相互调节彼此的代谢，并影响细胞增殖、成熟、矿化以及骨吸收的激活。本研究旨在评估生长激素缺乏症患儿在基线期及重组人生长激素（rhGH）治疗期间，骨形成标志物[碱性磷酸酶（ALP）、骨碱性磷酸酶（BALP）]、GH/IGF-1轴与25-羟基维生素D[25(OH)D]之间的相互关系。在这项为期三年的前瞻性研究纳入的53例患者中评估了ALP、BALP、25(OH)D和IGF-1水平。在rhGH治疗期间，ALP、BALP和IGF-1升高。基线ALP活性与基线身高增长速度（HV）呈正相关。治疗第1年时，12个月时的ALP和BALP活性与HV呈正相关。我们发现，在基线期及治疗第1年时，ALP与IGF-1之间存在正相关；在治疗第1年时，12个月时的BALP活性与rhGH剂量之间存在正相关；在rhGH治疗第1年时的胆钙化醇剂量与rhGH治疗期间BALP活性的早期变化之间存在正相关。我们的结果表明，补充维生素D可增强rhGH对骨形成过程的作用，这可能会改善rhGH治疗的效果。ALP和BALP活性有助于早期预测rhGH治疗的效果，但其作为长期预测指标的效用似乎不足。
