Dorrepaal Demi J, Goedegebuure Wesley J, van der Steen Manouk, Bos Daniel, Hokken-Koelega Anita C S
Department of Pediatrics, Erasmus MC - University Medical Center-Sophia Children's Hospital, 3015 CN, Rotterdam, the Netherlands.
Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center, 3015 CN, Rotterdam, the Netherlands.
EClinicalMedicine. 2024 May 15;72:102637. doi: 10.1016/j.eclinm.2024.102637. eCollection 2024 Jun.
Increased cerebrovascular morbidity was reported in adults born small for gestational age (SGA) who were treated with growth hormone (GH) during childhood compared to the general population. Yet, previous studies lacked an appropriate control group which is a major limitation. We prospectively studied cerebral white matter hyperintensities (WMHs) in adults born SGA at 12 years after cessation of childhood GH-treatment (SGA-GH), compared to appropriate controls.
In this prospective cohort study, performed between May 2016 and December 2020, total WMHs, periventricular WMHs (PVWMHs) and deep WMHs (DWMHs) were the primary outcomes of the study, they were qualitatively assessed using 3 Tesla (T) Magnetic Resonance Imaging (MRI) and scored using the Fazekas scale in SGA-GH adults and in 3 untreated control groups: adults born SGA with persistent short stature (SGA-S), adults born SGA with spontaneous catch-up growth to a normal height (SGA-CU) and adults born appropriate for gestational age with a normal height (AGA). Regression analyses were performed in the total cohort to evaluate the associations of GH-treatment and birth characteristics with WMHs.
297 adults were investigated (91 SGA-GH, 206 controls). Prevalence of total WMHs was 53.8% (95% CI 43.1-64.3) in SGA-GH, 40.5% (95% CI 25.6-56.7) in SGA-S, 73.9% (95% CI 61.9-83.7) in SGA-CU and 41.1% (95% CI 31.1-51.6) in AGA adults. No statistically significant differences in total WMHs, PVWMHs and DWMHs were found between SGA-GH compared to SGA-S and AGA adults. Highest prevalence of all type of WMHs was found in SGA-CU adults compared to all groups. Higher prevalence of total WMHs was associated with lower birth weight standard deviation score (SDS), but not with GH-treatment.
Our findings suggest that GH-treatment in children born SGA has no negative impact on the prevalence of all type of WMHs at 12 years after GH cessation compared to appropriate controls. SGA-CU adults had the highest prevalence of all type of WMHs around age 30 years.
Novo Nordisk.
据报道，与普通人群相比，在儿童期接受生长激素（GH）治疗的小于胎龄儿（SGA）成人的脑血管疾病发病率有所增加。然而，以往的研究缺乏合适的对照组，这是一个主要的局限性。我们前瞻性地研究了在儿童期GH治疗停止12年后出生的SGA成人（SGA-GH）的脑白质高信号（WMH），并与合适的对照组进行了比较。
在2016年5月至2020年12月期间进行的这项前瞻性队列研究中，总WMH、脑室周围WMH（PVWMH）和深部WMH（DWMH）是该研究的主要结局，使用3特斯拉（T）磁共振成像（MRI）对其进行定性评估，并使用Fazekas量表对SGA-GH成人和3个未治疗的对照组进行评分：出生时SGA且身材持续矮小的成人（SGA-S）、出生时SGA且自发追赶生长至正常身高的成人（SGA-CU）以及出生时适于胎龄且身高正常的成人（AGA）。在整个队列中进行回归分析，以评估GH治疗和出生特征与WMH的关联。
共调查了297名成人（91名SGA-GH，206名对照组）。SGA-GH组总WMH的患病率为53.8%（95%CI 43.1-64.3），SGA-S组为40.5%（95%CI 25.6-56.7），SGA-CU组为73.9%（95%CI 61.9-83.7），AGA成人为41.1%（95%CI 31.1-51.6）。与SGA-S组和AGA成人相比，SGA-GH组在总WMH、PVWMH和DWMH方面未发现统计学上的显著差异。与所有组相比，SGA-CU成人中所有类型WMH的患病率最高。总WMH的较高患病率与较低的出生体重标准差评分（SDS）相关，但与GH治疗无关。
我们的研究结果表明，与合适的对照组相比，SGA儿童接受GH治疗在停止GH治疗12年后对所有类型WMH的患病率没有负面影响。SGA-CU成人在30岁左右时所有类型WMH的患病率最高。
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