Ikegami Tomomi, Araki Shunsuke, Kuwamura Mami, Taku Aoi, Saito Reiko, Goto Motohide, Kubo Kazuyasu, Kawagoe Rinko, Yamamoto Yukiyo, Kawada Yasusada, Kusuhara Koichi
Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan.
Department of Pediatrics, Tobata General Hospital , Japan.
J UOEH. 2018;40(3):253-257. doi: 10.7888/juoeh.40.253.
Growth hormone (GH) therapy for short children born small for gestational age (SGA) has been approved in Japan. It is important to evaluate GH secretion ability before the initiation of GH therapy because there are some differences in dose and medical expenses between short children born SGA and GH deficiency (GHD). This study was designed to elucidate the incidence of GHD and to find a useful marker for detecting it in short SGA children. We retrospectively reviewed medical records to analyze the clinical features of short children born SGA and with GHD who had started GH therapy before the age of 6 in the University Hospital of Occupational and Environmental Health and Kyushu Rousai Hospital. Nine of 22 SGA subjects (41%) had GHD. There were no significant differences between two groups of short SGA children (GHD, non-GHD) in the median of height and serum insulin-like growth factors (IGF)-1 levels at birth or at the start of GH therapy. The probability of GHD was higher if the height standard deviation scores (SD) of the SGA children were lower than -3.2 (odds ratio, 11.6; 95% confidence interval, 1.52 - 89.1, P = 0.013). This study showed that there is an approximately 40% incidence of GHD in short SGA children needing GH treatment. We should do GH stimulation tests for short SGA children whose height SD is lower than -3 to determine the appropriate GH therapy.
生长激素（GH）治疗小于胎龄儿（SGA）出生的矮小儿童在日本已获批准。在开始GH治疗前评估GH分泌能力很重要，因为SGA出生的矮小儿童与生长激素缺乏症（GHD）儿童在剂量和医疗费用方面存在一些差异。本研究旨在阐明GHD的发生率，并找到一种在SGA矮小儿童中检测GHD的有用标志物。我们回顾性分析了在职业与环境卫生大学医院和九州 Rousai 医院6岁前开始接受GH治疗的SGA出生且患有GHD的矮小儿童的病历，以分析其临床特征。22名SGA受试者中有9名（41%）患有GHD。两组SGA矮小儿童（GHD组、非GHD组）在出生时或开始GH治疗时的身高中位数和血清胰岛素样生长因子（IGF）-1水平无显著差异。如果SGA儿童的身高标准差评分（SD）低于-3.2，GHD的可能性更高（优势比，11.6；95%置信区间，1.52 - 89.1，P = 0.013）。本研究表明，在需要GH治疗的SGA矮小儿童中，GHD的发生率约为40%。对于身高SD低于-3的SGA矮小儿童，我们应进行GH刺激试验以确定合适的GH治疗方案。
