Hokken-Koelega A C, Stijnen T, de Ridder M A, de Muinck Keizer-Schrama S M, Wolff E D, de Jong M C, Donckerwolcke R A, Groothoff J W, Blum W F, Drop S L
Department of Pediatrics, Sophia Children's Hospital, Rotterdam, Netherlands.
Lancet. 1994 May 28;343(8909):1313-7. doi: 10.1016/s0140-6736(94)92465-1.
Growth failure is a psychosocial problem for many patients who have undergone renal transplantation. 18 adolescents (mean age 15.6, range 11.3-19.5) with severe growth retardation after renal transplantation were treated with biosynthetic growth hormone (GH) for 2 years. All received prednisone, administered daily or on alternate days, with azathioprine and/or cyclosporin A. 16 were blindly assigned to one of two GH doses (4 vs 8 IU per m2 per day). Growth, bone maturation, renal graft function, plasma insulin-like growth factors, serum binding proteins, and other biochemical parameters were checked regularly. Glomerular filtration rate and effective renal plasma flow were tested with 125I-Thalamate and 131I-Hippuran. Data on growth and glomerular filtration rate during GH treatment were also compared with those of matched non-GH-treated controls. Mean (standard deviation) increment in height after 2 years of GH was 15.7 (5.1) cm, significantly greater (p < 0.0001) than in matched controls, 5.8 (3.4) cm. Results were similar for the two GH dosage groups. Bone maturation was not accelerated. Glomerular filtration rate and effective renal plasma flow did not change significantly. The incidence of a > 25% reduction in glomerular filtration rate over 2 years was not significantly higher in GH-treated patients than in non-GH-treated controls (39% vs 32%, p = 0.97). Although a few patients had deterioration of graft function, we could not find a relation with GH treatment. Our results show that sustained improvement of height can be achieved with GH in severely growth-retarded adolescents after renal transplantation.
生长发育迟缓是许多肾移植患者面临的一个社会心理问题。18例肾移植后出现严重生长发育迟缓的青少年（平均年龄15.6岁，范围11.3 - 19.5岁）接受了2年的生物合成生长激素（GH）治疗。所有患者均接受泼尼松治疗，每日或隔日给药，并联合硫唑嘌呤和/或环孢素A。16例患者被随机分配至两种GH剂量组之一（每天每平方米4 IU或8 IU）。定期检查生长情况、骨成熟度、肾移植功能、血浆胰岛素样生长因子、血清结合蛋白及其他生化参数。用125I-碘肽酸盐和131I-马尿酸进行肾小球滤过率和有效肾血浆流量检测。还将GH治疗期间的生长数据和肾小球滤过率与匹配的未接受GH治疗的对照组进行比较。GH治疗2年后身高的平均（标准差）增加值为15.7（5.1）cm，显著高于匹配对照组的5.8（3.4）cm（p < 0.0001）。两个GH剂量组的结果相似。骨成熟未加速。肾小球滤过率和有效肾血浆流量无显著变化。接受GH治疗的患者在2年内肾小球滤过率降低> 25%的发生率并不显著高于未接受GH治疗的对照组（39%对32%，p = 0.97）。虽然有少数患者移植功能恶化，但我们未发现与GH治疗有关。我们的结果表明，肾移植后严重生长发育迟缓的青少年使用GH可实现身高的持续改善。
