Wühl E, Haffner D, Nissel R, Schaefer F, Mehls O
Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
Pediatr Nephrol. 1996 Jun;10(3):294-8. doi: 10.1007/BF00866763.
Recombinant human growth hormone (rhGH) is a new treatment modality for short children with chronic renal failure (CRF) prior to and during dialysis. It is difficult to analyze whether dialysis patients respond less to rhGH than children with CRF on conservative treatment because they are older and often in a pubertal age range. One hundred and eight patients were treated with 28-30 IU rhGH/kg per week for at least 1 year. We analyzed the growth response to rhGH in 56 prepubertal patients aged less than 10 years at the start of rhGH treatment; 38 children with a mean age of 6.5 +/- 2.4 years were on conservative treatment (CT) and 18 patients with a mean age of 6.5 +/- 2 years on dialysis treatment (D). Mean height velocity was 4.9 +/- 2.3 cm/year in children on CT and 4.6 +/- 1.8 cm/year in children on D. During the 1st treatment year, height velocity was 9.5 +/- 3.8 cm/year in CT patients and 7.3 +/- 1.3 cm/year in D patients (P < 0.05). The change in height was +1.1 +/- 0.8 standard deviation (SD) in CT patients and +0.5 +/- 0.4 SD in D patients (P < 0.005). During the 2nd treatment year, the change in height was again greater in CT patients (0.5 +/- 0.4 SD vs. 0.2 +/- 0.4 SD; P < 0.05). The difference in height velocity and change in height standard deviation score was also significant when a subgroup of patients was matched for sex, age, height. Height velocity and the change in height velocity during rhGH treatment were not correlated with residual renal function, the degree of anemia, or metabolic acidosis. We conclude that short children on D respond less to rhGH than short children on CT, indicating a greater insensitivity to rhGH during D treatment.
重组人生长激素（rhGH）是一种用于慢性肾衰竭（CRF）患儿透析前及透析期间的新治疗方式。很难分析透析患者对rhGH的反应是否比接受保守治疗的CRF患儿少，因为他们年龄较大且常处于青春期年龄段。108例患者接受每周28 - 30 IU rhGH/kg的治疗，疗程至少1年。我们分析了56例rhGH治疗开始时年龄小于10岁的青春期前患者对rhGH的生长反应；38例平均年龄为6.5±2.4岁的儿童接受保守治疗（CT），18例平均年龄为6.5±2岁的患者接受透析治疗（D）。CT组儿童的平均身高增长速度为4.9±2.3厘米/年，D组儿童为4.6±1.8厘米/年。在治疗的第1年，CT组患者的身高增长速度为9.5±3.8厘米/年，D组患者为7.3±1.3厘米/年（P<0.05）。CT组患者身高变化为+1.1±0.8标准差（SD），D组患者为+0.5±0.4 SD（P<0.005）。在治疗的第2年，CT组患者的身高变化再次更大（0.5±0.4 SD对0.2±0.4 SD；P<0.05）。当按性别、年龄、身高匹配患者亚组时，身高增长速度和身高标准差得分变化的差异也很显著。rhGH治疗期间的身高增长速度和身高增长速度变化与残余肾功能、贫血程度或代谢性酸中毒无关。我们得出结论，接受透析治疗的矮小儿童对rhGH的反应比接受保守治疗的矮小儿童少，表明在透析治疗期间对rhGH的敏感性较低。
