Müller H L, Klinkhammer-Schalke M, Kühl J
Department of Pediatrics, University Hospital, Würzburg, Germany.
Exp Clin Endocrinol Diabetes. 1998;106(2):135-9. doi: 10.1055/s-0029-1211965.
The aim of this study was to investigate growth and final height in young adults after therapy for malignant diseases. Final height and weight was studied in 50 long-term survivors (LTS) of childhood cancer (aged 17-31 years; 30 men, 20 women) 3-18 years after treatment for malignant diseases (7 acute lymphoblastic leukemia, 20 lymphoma, 8 sarcoma, 15 malignant central nervous system [CNS] tumours). None of the LTS had been treated with growth hormone (GH). A decrease in final height SDS (Standard deviation score) occurred in both LTS of malignant CNS tumours (median height SDS at diagnosis, 0.3; range, -0.9 to 2.2; median final height SDS, -1.3; range, -3.9 to 1.9; p < 0.01) and LTS of lymphoma (p < 0.05) or leukemia (p < 0.05). However, only LTS who received cranial (p < 0.05) or craniospinal (p < 0.001) irradiation (XRT) exhibited reduced final heights. LTS who had received XRT not involving the CNS or had received no XRT at all presented no reduction in final height. LTS of CNS tumours treated with high craniospinal XRT doses (24 to 56 Gy) reached lower (p < 0.01) final heights when compared with LTS of leukemia who received lower cranial XRT doses (18 to 24 Gy). Final height SDS correlated with chronological age at initiation of therapy (p < 0.05). No correlation was found between the cumulative doses of applied chemotherapeutic agents and the final height of LTS. During follow-up LTS developed an increase in weight for height index (WFH) which occurred independent of XRT. In conclusion, cranial and craniospinal XRT especially in young children with malignancies resulted in a decrease in final height SDS. As 6 of 15 LTS of malignant CNS tumours exhibited a final height SDS below -2 SD, analysis of pituitary function and substitution of GH after diagnosis of GH deficiency should be considered for these patients at a young age. Others factors not directly related to XRT are responsible for the increased risk for obesity in LTS of childhood cancer.
本研究的目的是调查恶性疾病治疗后年轻成年人的生长情况和最终身高。对50名儿童癌症长期幸存者（LTS）（年龄17 - 31岁；男性30名，女性20名）在恶性疾病治疗后3至18年的最终身高和体重进行了研究（7例急性淋巴细胞白血病、20例淋巴瘤、8例肉瘤、15例恶性中枢神经系统[CNS]肿瘤）。所有LTS均未接受过生长激素（GH）治疗。恶性CNS肿瘤的LTS（诊断时中位身高SDS为0.3；范围为 - 0.9至2.2；最终中位身高SDS为 - 1.3；范围为 - 3.9至1.9；p < 0.01）以及淋巴瘤（p < 0.05）或白血病（p < 0.05）的LTS的最终身高SDS均出现下降。然而，只有接受头颅（p < 0.05）或全脑脊髓（p < 0.001）照射（XRT）的LTS最终身高降低。接受不涉及CNS的XRT或根本未接受XRT的LTS最终身高未降低。与接受较低头颅XRT剂量（18至24 Gy）的白血病LTS相比，接受高剂量全脑脊髓XRT（24至56 Gy）治疗的CNS肿瘤LTS达到的最终身高更低（p < 0.01）。最终身高SDS与治疗开始时的实际年龄相关（p < 0.05）。未发现所用化疗药物的累积剂量与LTS的最终身高之间存在相关性。在随访期间，LTS的身高体重指数（WFH）增加，且与XRT无关。总之，头颅和全脑脊髓XRT，尤其是在患有恶性肿瘤的幼儿中，导致最终身高SDS降低。由于15例恶性CNS肿瘤的LTS中有6例的最终身高SDS低于 - 2 SD，对于这些年幼患者，在诊断为生长激素缺乏后应考虑分析垂体功能并补充生长激素。儿童癌症LTS肥胖风险增加的原因是其他与XRT无直接关系的因素。
