接受化疗的癌症患儿的生长及生长激素分泌情况

Growth and growth hormone secretion in children with cancer treated with chemotherapy.

作者信息

Roman J, Villaizán C J, García-Foncillas J, Salvador J, Sierrasesúmaga L

机构信息

Department of Pediatric Oncology, Clínica Universitaria de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain.

出版信息

J Pediatr. 1997 Jul;131(1 Pt 1):105-12. doi: 10.1016/s0022-3476(97)70132-x.

DOI:10.1016/s0022-3476(97)70132-x

PMID:9255200

Abstract

OBJECTIVE

To evaluate the effect of chemotherapy on growth and growth hormone (GH) secretion.

METHODS

We analyzed growth and GH secretion in 60 children in complete remission after treatment by chemotherapy and surgery for malignant solid tumors. None of them received cranial radiotherapy. Growth hormone reserve was assessed by at least two stimulation tests (clonidine, L-dopa, growth hormone-releasing hormone). In 12 children the reserve of GH pretreatment was also evaluated.

RESULTS

Growth hormone deficiency (GHD) was observed in 27 of 60 patients (45%). At diagnosis, mean standing height was +0.23 +/- 0.11 standard deviation score (SDS) in the GHD group and +0.16 +/- 0.10 SDS in the non-GHD group. After chemotherapy, mean standing height in the GHD group was -0.28 +/- 0.15 SDS and -0.14 +/- 0.11 in the non-GHD group (p < 0.05), and the growth rate was +0.13 +/- 0.07 SDS in the GHD group and +0.22 +/- 0.18 SDS in the non-GHD group. For a mean follow-up of 30 months, the mean standing height was -0.46 +/- 0.29 SDS in the GHD group and -0.24 +/- 0.16 SDS for the non-GHD group (p < 0.05), and the growth rate was -0.27 +/- 0.19 SDS in the GHD group and -0.16 +/- 0.12 SDS in the non-GHD group (p < 0.05). The GH response to clonidine was significantly less than that found with the other stimuli. There was correlation between the dose intensity of some drugs and the subsequent GH response to stimulation tests. The GHD group was found to have received significantly higher doses of actinomycin D than the non-GHD group (p < 0.05). Growth impairment and GHD were not found to be correlated with duration of treatment and follow-up, tumor type, sex, or age.

CONCLUSIONS

Chemotherapy as the sole form of treatment in children with cancer interferes with growth. The observed impairment of growth depends, at least in part, on a GHD related to chemotherapy. The growth rate in conjunction with the GH response to clonidine provides a sensitive measure of GHD associated with chemotherapy.

摘要

目的

评估化疗对生长及生长激素（GH）分泌的影响。

方法

我们分析了60名经化疗及手术治疗后处于完全缓解期的恶性实体瘤患儿的生长情况及GH分泌。他们均未接受颅脑放疗。通过至少两项刺激试验（可乐定、左旋多巴、生长激素释放激素）评估生长激素储备。对12名患儿还评估了化疗前的GH储备。

结果

60例患者中有27例（45%）出现生长激素缺乏（GHD）。诊断时，GHD组平均站立身高为+0.23±0.11标准差评分（SDS），非GHD组为+0.16±0.10 SDS。化疗后，GHD组平均站立身高为-0.28±0.15 SDS，非GHD组为-0.14±0.11 SDS（p<0.05），GHD组生长速率为+0.13±0.07 SDS，非GHD组为+0.22±0.18 SDS。平均随访30个月时，GHD组平均站立身高为-0.46±0.29 SDS，非GHD组为-0.24±0.16 SDS（p<0.05），GHD组生长速率为-0.27±0.19 SDS，非GHD组为-0.16±0.12 SDS（p<0.05）。可乐定刺激后的GH反应明显低于其他刺激。某些药物的剂量强度与随后刺激试验的GH反应之间存在相关性。发现GHD组接受的放线菌素D剂量明显高于非GHD组（p<0.05）。生长障碍和GHD与治疗及随访时间、肿瘤类型、性别或年龄无关。