Samuelsson B O, Márky I, Rosberg S, Albertsson-Wikland K
Department of Pediatrics, University of Göteborg, Sweden.
Med Pediatr Oncol. 1997 Jan;28(1):27-34. doi: 10.1002/(sici)1096-911x(199701)28:1<27::aid-mpo6>3.0.co;2-v.
The aim of this study was to evaluate the growth and growth hormone (GH) secretion, as assessed by the rate and pattern of secretion, in patients in remission from non-Hodgkin's lymphoma (NHL) who had been treated with corticosteroids and intense chemotherapy. None of the patients had received cranial irradiation. Twelve children were investigated yearly by taking 24-hour GH profiles starting 1 year from the time of diagnosis. The mean age at onset of the disease was 7.5 years. Another 12 young adults were studied in a cross-sectional manner 4.1-21.3 years (mean, 9.0 years) after diagnosis of NHL. The mean age at onset of the disease was 10.7 years. The median height velocity was significantly decreased during the 1st year following diagnosis (standard deviation scores [SDS] -0.15, P < .001), especially during the first 3 months (SDS -0.75, P < .001) when the most intense treatment was given. During the 2nd year height velocity was still somewhat reduced (SDS -0.13, P < .001). However, there was no reduction in final attained height. Spontaneous GH secretion, in terms of both secretory rate and pulsatile pattern, was evaluated by measuring integrated GH concentrations in 20-minute blood samples collected over a 24-hour period. The plasma GH concentrations were transformed into GH secretion rates by means of a deconvolution technique. Fourier time series analysis was applied to determine possible disturbances of rhythmicity of the GH secretion. The GH secretion rate and the pulsatile pattern of secretion in the NHL patients were similar to those of the reference population of pubertal matched healthy controls. There was no influence of the age at diagnosis or of the time from diagnosis of NHL on the GH secretion rate. Growth impairment in children with a malignant disease treated only with steroids and chemotherapy is therefore probably not caused by disturbed GH secretion, but rather by direct interference with bone growth of the cytotoxic drugs used. There was no significant influence on weight gain during the treatment period so an indirect effect of chemotherapy on bone growth through interference with adequate nutrition seems unlikely. However, GH secretion was not evaluated during the period of growth retardation, and therefore a transient deficiency was not excluded.
本研究的目的是评估接受皮质类固醇和强化化疗治疗后处于缓解期的非霍奇金淋巴瘤（NHL）患者的生长情况以及生长激素（GH）分泌情况（通过分泌速率和模式进行评估）。所有患者均未接受过颅脑放疗。从诊断时间起1年开始，对12名儿童每年进行一次24小时GH谱检测。疾病发病时的平均年龄为7.5岁。另外12名年轻成人在NHL诊断后4.1 - 21.3年（平均9.0年）以横断面方式进行研究。疾病发病时的平均年龄为10.7岁。诊断后的第1年中，身高速度中位数显著降低（标准差评分[SDS] -0.15，P <.001），尤其是在给予最强化治疗的前3个月（SDS -0.75，P <.001）。第2年身高速度仍有所降低（SDS -0.13，P <.001）。然而，最终达到的身高没有降低。通过测量24小时内每隔20分钟采集的血样中GH的综合浓度，评估自发性GH分泌的分泌速率和脉冲模式。通过反卷积技术将血浆GH浓度转化为GH分泌速率。应用傅里叶时间序列分析来确定GH分泌节律可能存在的紊乱。NHL患者的GH分泌速率和分泌脉冲模式与青春期匹配的健康对照参考人群相似。诊断时的年龄或NHL诊断后的时间对GH分泌速率没有影响。因此，仅接受类固醇和化疗治疗的恶性疾病儿童的生长障碍可能不是由GH分泌紊乱引起的，而是由所用细胞毒性药物对骨骼生长的直接干扰导致的。治疗期间对体重增加没有显著影响，因此化疗通过干扰充足营养对骨骼生长产生间接影响的可能性似乎不大。然而，在生长迟缓期间未评估GH分泌，因此不排除短暂性缺乏的可能性。
