Cicognani A, Cacciari E, Vecchi V, Cau M, Balsamo A, Pirazzoli P, Tosi M T, Rosito P, Paolucci G
Second and Third Pediatric Clinics, University of Bologna, Italy.
Am J Dis Child. 1988 Nov;142(11):1199-202. doi: 10.1001/archpedi.1988.02150110077023.
To evaluate the effects of two different doses of cranial irradiation on growth and growth hormone (GH) release, we studied 61 children with acute lymphocytic leukemia who had survived at least five years in continuous complete remission. Forty-three children received 24 Gy (group 1) and 18 children received 18 Gy (group 2). Height was evaluated at diagnosis, at the end of treatment, and 6, 12, and 24 months later. Growth hormone release was evaluated by arginine and levodopa tests after the end of treatment. After diagnosis, the height SD score decreased significantly in both groups; two years after the end of treatment, only group 1 showed an SD score for height that was still significantly lower than at diagnosis. Group 1 showed impaired GH responses to the tests and, compared with controls, group 1 in fact included a percentage of subjects with a normal response to levodopa (ie, greater than 8 micrograms/L) that was significantly lower (56.4% vs 83.3%) and a percentage of nonresponders to both tests that was significantly higher (21.6% vs 0%). These data indicate that only patients treated with lower cranial irradiation dosage (18 Gy) had complete growth recovery and normal GH responses to pharmacologic tests.
为评估两种不同剂量的颅脑照射对生长及生长激素（GH）释放的影响，我们研究了61例急性淋巴细胞白血病患儿，这些患儿已持续完全缓解至少5年。43例患儿接受24 Gy照射（第1组），18例患儿接受18 Gy照射（第2组）。在诊断时、治疗结束时以及治疗结束后6、12和24个月评估身高。治疗结束后通过精氨酸和左旋多巴试验评估生长激素释放。诊断后，两组患儿的身高标准差评分均显著下降；治疗结束两年后，只有第1组的身高标准差评分仍显著低于诊断时。第1组对试验的GH反应受损，与对照组相比，第1组中对左旋多巴反应正常（即大于8微克/升）的受试者百分比显著更低（56.4%对83.3%），对两项试验均无反应的受试者百分比显著更高（21.6%对0%）。这些数据表明，只有接受较低颅脑照射剂量（18 Gy）治疗的患者实现了完全的生长恢复以及对药物试验的正常GH反应。
