重组人生长激素对38例特纳综合征的疗效观察

目的探讨重组人生长激素(rhGH)治疗特纳综合征(TS)的疗效及影响疗效的因素。方法选取确诊为TS的患儿38例为研究对象,每晚均接受rhGH治疗,剂量0.11～0.21 IU.kg-1.d-1,疗程6～36个月。定期随访,观察生长速率(GV)、胰岛素样生长因子-1(IGF-1)和甲状腺功能、肝功能、糖化血红蛋白等。按照rhGH用药剂量将患儿分为2组,≤0.15 IU.kg-1.d-1组和>0.15 IU.kg-1.d-1组,分析不同剂量与疗效的关系。按照治疗初始年龄将患儿分成≤10岁组及>10岁组,分析治疗年龄与疗效的关系。按照治疗前生长激素(GH)峰值将患儿分成GH≥10μg.L-1组及<10μg.L-1组,观察疗效与治疗前GH峰值的关系。结果 TS患儿用药前及用药0.5 a后GV(2.47±0.42)cm.a-1vs(9.37±2.68)cm.a-1]比较差异有统计学意义(P=0.001)。IGF-1由用药前(186.73±73.32)μg.L-1增至用药后0.5 a(433.93±163.91)μg.L-1,二者比较差异有统计学意义(P<0.001)。rhGH剂量与GV无显著相关。治疗初始年龄与第1年GV无关。治疗前GH峰值与GV无显著相关。结论 rhGH治疗TS可以明确改善身高。较以往常用剂量更小的剂量也可以达到很好的疗效。用药前患儿GH峰值与疗效关系不大,可以不用常规做GH激发试验。患儿治疗的初始年龄与GV无明显相关性。IGF-1是治疗过程中的重要检测指标。

Clinical Observation of Recombinant Human Growth Hormone on 38 Patients with Turner Syndrome

Objective To analyze the treatment effect of recombinant human growth hormone(rhGH) on Turner syndrome(TS) and the factors which affected the treatment effect. Methods Thirty-eight cases of TS patients were chosen as research subjects,and they were all treated with rhGH,with a dose of 0.11-0.21 IU·kg-1·d-1 for 6-36 months′ treatment.All the patients were followed up periodically.Seven indexes including growth velocity(GV),insulin-like growth factor 1(IGF-1),thyroid function,liver function and HbA1c were observed.First of all,according to the dosage of rhGH,the patients were divided into 2 groups:≤0.15 IU·kg-1·d-1 group and >0.15 IU·kg-1·d-1 group,and the relationship between the treatment effect and the dosage of rhGH was observed.Secondly,according age of initial treatment,the patients were divided into ≤10 years old group and >10 years old group,and the association between initial treatment age and the treatment effect was studied.Finally,the patients were divided again into GH≥10 μg·L-1 group and <10 μg·L-1 group according to the GH peak value before treatment,and the association between the treatment effect and the GH peak value before treatment was studied. Results After treatment,the average GV was increased from(2.47±0.42) cm·a-1to(9.37±2.68) cm·a-1(P=0.000).The average IGF-1 value was increased from(186.73±73.32) μg·L-1 to(433.93±163.91) μg·L-1(P<0.001).No significant relationship between GH dosage and GV was observed.Also,no significant association between the age of initial treatment and the first year′s GV was observed,so did the growth peak before treatment and the GV. Conclusions GH can certainly improve the body height of the patients with TS.GH dosage less than that of the usual treatment dosage can attain better treatment effect.The GH peak value before treatment has no significant relationship with the treatment effect,thus GH stimulating test is not necessary for the patients.IGF-1 is a good index during the treatment of GH on the patients.