Hochberg Z, Leiberman E, Landau H, Koren R, Zadik Z
Department of Pediatrics, Rambam Medical Centre, Haifa, Israel.
Clin Endocrinol (Oxf). 1994 Sep;41(3):331-5. doi: 10.1111/j.1365-2265.1994.tb02553.x.
Final adult height is determined by both childhood and pubertal growth. The later is a function of growth velocity and bone maturation, and both are regulated by growth hormone. In a study of the safety and efficacy of GH therapy, we analysed the impact of age on bone maturation and predicted adult height.
The subjects were 65 male patients with GH deficiency, as diagnosed by pharmacological or physiological tests, who participated in a multicentre trial and completed 3 years of hGH therapy. The age range at initiation of therapy was 3.1-15.7 years. Subcutaneous injections of hGH were given in a dose of 0.3 mg/kg/week, in thrice-weekly doses. Calculation of the adult height prediction was performed on annual growth parameters using the Bailey-Pinneau, TW-II and Roche methods.
The rate of pubertal advancement correlated positively with the child's age at initiation of therapy. The bone age advanced in positive correlation with chronological age, and by the end of 3 years of hGH therapy the delta-bone age/delta-chronological age ratio increased to 1.5 for children with an age at start of therapy of 10.7 years. During the adolescent years, the predicted gained height over 3 years of therapy declined, in correlation with age, and became negative at a therapy-initiation age of 12.9 years.
In a retrospective analysis of a group of children with heterogeneous GH secretory ability, GH induced acceleration of growth, around the age of normal puberty, advanced the age of pubertal onset and accelerated pubertal progression which, in turn, expedited bone maturation and thereby restricted predicted adult height gain from hGH therapy.
成人最终身高由儿童期和青春期生长共同决定。青春期生长是生长速度和骨骼成熟的函数，两者均受生长激素调节。在一项生长激素（GH）治疗安全性和有效性的研究中，我们分析了年龄对骨骼成熟和预测成人身高的影响。
受试者为65例经药理学或生理学检测诊断为生长激素缺乏的男性患者，他们参与了一项多中心试验并完成了3年的重组人生长激素（hGH）治疗。治疗开始时的年龄范围为3.1至15.7岁。皮下注射hGH的剂量为0.3mg/kg/周，每周三次。使用贝利-平诺法、TW-II法和罗氏法根据年度生长参数计算成人身高预测值。
青春期发育速度与治疗开始时儿童的年龄呈正相关。骨龄与实际年龄呈正相关，在hGH治疗3年末，治疗开始年龄为10.7岁的儿童，其骨龄变化/实际年龄变化比值增至1.5。在青少年时期，3年治疗期间预测的身高增长随年龄增加而下降，在治疗开始年龄为12.9岁时变为负值。
在一组生长激素分泌能力各异的儿童的回顾性分析中，生长激素在正常青春期年龄左右诱导生长加速，使青春期开始年龄提前并加速青春期进程，这反过来又加速了骨骼成熟，从而限制了生长激素治疗预测的成人身高增长。
