Pasqualini T, Ferraris J
Sección Endocrinología, Hospital Italiano, Buenos Aires.
Medicina (B Aires). 1998;58(3):265-70.
Children with chronic renal disease may improve height with growth hormone (GH) treatment. We studied 2 groups of children with height below 1.8 SDS and/or height velocity (HV) below the 3rd centile: 1) 6 patients with end stage renal disease (ESRD) on dialysis, aged 12.2 +/- 4.4 years (x +/- sd), with bone age of 6.8 +/- 3.3 years, 3 with Tanner stage I and 3 Tanner II; and 2) 6 children with functioning renal transplants, aged 15.5 +/- 2.5 years, with bone age 10.0 +/- 2.3 years, Tanner II-IV. Maintenance dosage of orally administered methylprednisone (MP) was 0.16 +/- 0.04 mg/kg/day. 1) Children with ESRD received GH during 1 to 3.5 years. Height SDS and HV (x +/- sd) were: pre GH -3.8 +/- 0.6 SDS and 2.6 +/- 1.4 cm/y; at 1 year of GH therapy (n = 6) -3.9 +/- 0.4 SDS and 5.1 +/- 3.2 cm/y; at 2 years (n = 5) -4.2 +/- 0.5 SDS and 3.1 +/- 0.7 cm/y; at 3 years (n = 4) -4.1 +/- 0.7 SDS and 3.3 +/- 1.5 cm/y. Height SDS and HV were: pre GH -3.0 +/- 1.9 SDS and 3 +/- 1 cm/y; at 1 year -2.5 +/- 1.5 SDS (p < 0.05) (t paired test) and 6.9 +/- 2.3 cm/y (p < 0.01). Height SDS and HV increased; creatinine clearance remained stable; there was correlation between height SDS and serum creatinine r = -0.81, creatinine clearance and HV r = 0.92, MP dose and HV r = -0.85. Five of 6 patients reached adult height of -2.8 +/- 1.3 SDS, below their target height of -0,3 +/- 0.7 SDS (p < 0.005).
In patients with ESRD, GH therapy did not improve significantly height SDS and HV. In pubertal transplanted patients height SDS and HV improved and renal function remained stable; final height remained below expected genetic height. Prolonged periods of GH therapy are necessary to evaluate if final height can be improved with GH.
患有慢性肾病的儿童使用生长激素（GH）治疗可能会改善身高。我们研究了两组身高低于1.8标准差分值（SDS）和/或身高增长速度（HV）低于第3百分位数的儿童：1）6例接受透析的终末期肾病（ESRD）患者，年龄12.2±4.4岁（x±标准差），骨龄6.8±3.3岁，3例处于坦纳I期，3例处于坦纳II期；2）6例有功能的肾移植儿童，年龄15.5±2.5岁，骨龄10.0±2.3岁，坦纳II - IV期。口服甲泼尼龙（MP）的维持剂量为0.16±0.04mg/kg/天。1）ESRD患儿接受GH治疗1至3.5年。身高SDS和HV（x±标准差）分别为：GH治疗前 -3.8±0.6 SDS和2.6±1.4cm/年；GH治疗1年时（n = 6） -3.9±0.4 SDS和5.1±3.2cm/年；2年时（n = 5） -4.2±0.5 SDS和3.1±0.7cm/年；3年时（n = 4） -4.1±0.7 SDS和3.3±1.5cm/年。另一组身高SDS和HV分别为：GH治疗前 -3.0±1.9 SDS和3±1cm/年；1年时 -2.5±1.5 SDS（p < 0.05）（配对t检验）和6.9±2.3cm/年（p < 0.01）。身高SDS和HV增加；肌酐清除率保持稳定；身高SDS与血清肌酐之间存在相关性r = -0.81，肌酐清除率与HV之间r = 0.92，MP剂量与HV之间r = -0.85。6例患者中有5例达到成人身高 -2.8±1.3 SDS，低于其目标身高 -0.3±0.7 SDS（p < 0.005）。
在ESRD患者中，GH治疗未显著改善身高SDS和HV。在青春期肾移植患者中，身高SDS和HV有所改善且肾功能保持稳定；最终身高仍低于预期的遗传身高。需要长时间的GH治疗来评估是否可以通过GH改善最终身高。
