24周生长激素治疗对儿童期起病的成人生长激素缺乏症患者骨微结构和骨体积密度的影响。
Effects of 24 Weeks of Growth Hormone Treatment on Bone Microstructure and Volumetric Bone Density in Patients with Childhood-Onset Adult GH Deficiency.
作者信息
Yang Hongbo, Yan Kemin, Xu Yuping, Wang Linjie, Zhang Qi, Gong Fengying, Zhu Huijuan, Xia Weibo, Pan Hui
机构信息
Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, The Translational Medicine Center of PUMCH, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
出版信息
Int J Endocrinol. 2020 Mar 13;2020:9201979. doi: 10.1155/2020/9201979. eCollection 2020.
OBJECTIVE
Adults with childhood-onset growth hormone deficiency (CO AGHD) have prominently impaired volumetric bone density (vBMD) and bone microarchitecture. Effects of recombinant human growth hormone (rhGH) on bone microarchitecture in CO AGHD were insufficiently evaluated. The objective of this study is to assess the effects of rhGH on bone microarchitecture and vBMD in CO AGHD patients.
DESIGN
In this single-center prospective study, nine CO AGHD patients received rhGH treatment for 24 weeks. High-resolution peripheral quantitative computerized tomography (HR-pQCT) of distal tibia and radius was performed at baseline and at the end of treatment. Main outcomes were vBMD and morphometric parameters from HR-pQCT.
RESULTS
After 24-week treatment, IGF-1 SDS gradually increased from -3.31 ± 1.56 to -1.92 ± 1.65 (=0.113). Serum phosphate (1.17 ± 0.17 vs. 1.35 ± 0.18 mmol/L, =0.030), alkaline phosphatase (83.6 ± 38.6 vs. 120.5 ± 63.7, =0.045), and -CTX (0.67 ± 0.32 vs. 1.09 ± 0.58, =0.022) were significantly elevated. In distal tibia, total vBMD (200.2 ± 41.7 vs 210.3 ± 40.9 mg HA/cm, =0.017), cortical area (89.9 ± 17.7 vs 95.5 ± 19.9 mm, =0.032), and cortical thickness (0.891 ± 0.197 vs 0.944 ± 0.239 mm, =0.028) were significantly improved. Trabecular area decreased from 795.3 ± 280.9 to 789.6 ± 211.4 mm (=0.029). Trabecular bone volume fraction increased from 0.193 ± 0.038 to 0.198 ± 0.036 (=0.027). In radius, cortical perimeter (74.1 ± 10.0 vs 75.0 ± 10.9 mm, =0.034), trabecular thickness (0.208 ± 0.013 vs 0.212 ± 0.013 mm, =0.008), trabecular separation (0.743 ± 0.175 vs 0.796 ± 0.199 mm, =0.019), and inhomogeneity of network (Tb.1/N.SD) (0.292 ± 0.087 vs 0.317 ± 0.096 mm, =0.026) were significantly improved, while trabecular number (1.363 ± 0.294 vs 1.291 ± 0.325 1/mm, =0.025) decreased significantly.
CONCLUSIONS
Our results provide evidence for improvement of vBMD and bone microarchitecture in AGHD patients at a relatively early stage of rhGH treatment.
目的
患有儿童期起病的生长激素缺乏症（CO AGHD）的成年人骨体积密度（vBMD）和骨微结构显著受损。重组人生长激素（rhGH）对CO AGHD患者骨微结构的影响尚未得到充分评估。本研究的目的是评估rhGH对CO AGHD患者骨微结构和vBMD的影响。
设计
在这项单中心前瞻性研究中，9名CO AGHD患者接受了24周的rhGH治疗。在基线和治疗结束时对胫骨远端和桡骨进行高分辨率外周定量计算机断层扫描（HR-pQCT）。主要结局是来自HR-pQCT的vBMD和形态学参数。
结果
经过24周的治疗，IGF-1 SDS从-3.31±1.56逐渐增加至-1.92±1.65（P=0.113）。血清磷酸盐（1.17±0.17 vs. 1.35±0.18 mmol/L，P=0.030）、碱性磷酸酶（83.6±38.6 vs. 120.5±63.7，P=0.045）和β-CTX（0.67±0.32 vs. 1.09±0.58，P=0.022）显著升高。在胫骨远端，总vBMD（200.2±41.7 vs 210.3±40.9 mg HA/cm，P=0.017）、皮质面积（89.9±17.7 vs 95.5±19.9 mm，P=0.032）和皮质厚度（0.891±0.197 vs 0.944±0.239 mm，P=0.028）显著改善。骨小梁面积从795.3±280.9降至789.6±211.4 mm（P=0.029）。骨小梁骨体积分数从0.193±0.038增加至0.198±0.036（P=0.027）。在桡骨，皮质周长（74.1±10.0 vs 75.0±10.9 mm，P=0.034）、骨小梁厚度（0.208±0.0l3 vs 0.212±0.013 mm，P=OO8）、骨小梁间距（O.743±0.175 vs 0.796±0.199 mm，P=0.019）和网络不均匀性（Tb.1/N.SD）（0.292±0.087 vs 0.317±0.096 mm，P=0.026）显著改善，而骨小梁数量（1.363±0.294 vs 1.291±0.325 1/mm，P=0.025）显著减少。
结论
我们的结果为rhGH治疗相对早期的AGHD患者vBMD和骨微结构的改善提供了证据。
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