Saggese G, Baroncelli G I, Bertelloni S, Barsanti S
Department of Pediatrics, University of Pisa, Italy.
J Clin Endocrinol Metab. 1996 Aug;81(8):3077-83. doi: 10.1210/jcem.81.8.8768878.
The effect of long-term GH treatment on bone mass was examined in 32 children with GH deficiency (GHD) aged 7.2-16.3 yr by measuring radial (distal third, single-photon absorptiometry) and lumbar (L2-L4, dual energy x-ray absorptiometry) bone mineral density (BMD) (group A). All patients were longitudinally followed and received recombinant hGH therapy for a mean period of 48.2 +/- 13.2 months. BMD values were corrected for bone age and expressed as Z-score in comparison with normative data. In addition, lumbar BMD and lumbar BMD corrected for the estimated vertebral volumes were assessed in 11 patients with GHD aged 16.0 - 18.7 yr at the time they reached their final height (group B) and, in 17 subjects with familial short stature aged 16.4 - 19.8 yr, as controls (group C) for patients of group B. Patients of group B had received discontinuous treatment with pituitary-derived hGH and subsequently recombinant hGH (total duration of treatment 151.5 +/- 9.7 months). The off-treatment period was 4.7 +/- 2.6 months. Before treatment, patients of group A showed significantly reduced (P < 0.001) radial and lumbar BMD (-1.7 +/- 0.4 Z-score and -1.5 +/- 0.5 Z-score, respectively) compared with normative data. During treatment, radial and lumbar BMD Z-scores improved significantly (P < 0.001); in the patients treated for the longest time, the BMD was within 0.5 SD of age-matched mean levels. In patients of group B, lumbar BMD and lumbar BMD corrected for the estimated vertebral volumes were significantly reduced in comparison with subjects of group C (-1.2 +/- 0.4 Z-score and -1.0 +/- 0.4 Z-score, P < 0.01 and P < 0.03, respectively). The results show that children with GHD have reduced BMD. Optimal GH treatment improves BMD, whereas inappropriate treatment is a main cause of reduced BMD at time of final height. These findings suggest an important role of GH therapy in the attainment of peak bone mass in children with GHD. GH treatment should be continued until the attainment of peak bone mass irrespective of the height achieved.
通过测量桡骨（远端三分之一处，单光子吸收法）和腰椎（L2-L4，双能X线吸收法）骨密度（BMD），对32名年龄在7.2至16.3岁的生长激素缺乏症（GHD）儿童进行了长期生长激素治疗对骨量影响的研究（A组）。所有患者均接受纵向随访，并接受重组人生长激素治疗，平均疗程为48.2±13.2个月。骨密度值根据骨龄进行校正，并与标准数据比较后以Z值表示。此外，在11名年龄在16.0至18.7岁达到最终身高的GHD患者（B组）以及17名年龄在16.4至19.8岁的家族性矮小症患者（作为B组患者的对照组，C组）中，评估了腰椎骨密度以及根据估计椎体体积校正后的腰椎骨密度。B组患者接受过垂体源性生长激素间断治疗，随后接受重组人生长激素治疗（总治疗时长151.5±9.7个月）。停药期为4.7±2.6个月。治疗前，与标准数据相比，A组患者的桡骨和腰椎骨密度显著降低（P<0.001）（分别为-1.7±0.4 Z值和-1.5±0.5 Z值）。治疗期间，桡骨和腰椎骨密度Z值显著改善（P<0.001）；在治疗时间最长的患者中，骨密度在年龄匹配平均水平的0.5个标准差范围内。与C组受试者相比，B组患者的腰椎骨密度以及根据估计椎体体积校正后的腰椎骨密度显著降低（分别为-1.2±0.4 Z值和-1.0±0.4 Z值，P<0.01和P<0.03）。结果表明，GHD儿童的骨密度降低。最佳的生长激素治疗可改善骨密度，而不适当的治疗是最终身高时骨密度降低的主要原因。这些发现表明生长激素治疗在GHD儿童达到峰值骨量方面具有重要作用。无论达到的身高如何，生长激素治疗都应持续至达到峰值骨量。
