重组人生长激素治疗特发性矮身材儿童对骨代谢指标的影响

目的探讨重组人生长激素(rhGH)对特发性矮身材(ISS)儿童骨代谢指标的影响。方法选取2017年4月至2018年4月温州市妇女儿童医院收治的青春发育前期的ISS儿童作为观察组(n=40),另选取同期于儿童保健科体检合格的青春发育期前儿童作为对照组(n=40)。在正常饮食、睡眠基础上给予观察组患儿rhGH注射治疗,持续干预12个月。对观察组治疗前、治疗3月、6月、12月后进行生长发育指标、血糖相关指标、甲状腺功能指标、骨代谢指标进行测量。对照组于体检当日检测以上指标。结果治疗前观察组生长发育指标、骨代谢指标均明显低于对照组。观察组治疗12个月后,身高标准差(HtSDS)、体重、骨龄、生长速率的组内差别具有统计学意义(F值分别为2.730、9.510、6.010、52.250,均P <0.05),且随时间推移呈增高趋势。治疗后骨代谢指标骨源性碱性磷酸酶(BAP)、骨钙素(OC)、血清I型前胶原氨基端前肽(PINP)、胰岛素样生长因子1(IGF-1)、骨密度桡骨远端骨量(SOS)的组内差别均具有统计学意义(F值分别为49.900、10.480、19.760、77.960、3.310,均P <0.05),25-羟基维生素D325-(OH)D3]差别无统计学意义(P>0.05)。进一步比较后发现,治疗3个月、6个月、12个月后,BAP、OC、PINP、IGF-1随时间推移呈增高趋势,SOS则呈显著递减趋势。治疗前后观察组血糖相关指标、甲状腺功能指标与对照组比较均无显著差异(P>0.05)。观察组治疗期间出现2例皮肤红肿患儿(5.00%),1例头痛患儿(2.50%),2例空腹胰岛素、空腹血糖受损(5.00%)。结论 rhGH在治疗青春发育前期的ISS患儿中具有促进生长、改善骨代谢指标的作用,且对糖代谢及甲状腺功能无不良影响,具有较好安全性。

Effect of recombinant human growth hormone therapy on bone metabolism of children with idiopathic short stature

Objective To investigate effect of recombinant human growth hormone(rhGH) on bone metabolism of children with idiopathic short stature(ISS). Methods 40 prepuberal children with ISS(observation group) and 40 prepuberal healthy children(control group) in Department of Child Health of our hospital from April, 2017 to April, 2018 were enrolled. On the basis of normal diet and sleep, the prepuberal children with ISS in the observation group were given rhGH injection for 12 months. Growth and development indexes, blood glucose related indexes, thyroid function indexes and bone metabolism indexes of the children in the observation groups were measured and detected before treatment, at 3 months, 6 months and 12 months of the treatment, while the measurement and detection of the children in the control group were carried out at the day of physical examination. Results Before treatment, the growth and development indexes and bone metabolism indexes of the children in the observation group were significantly lower than those of the healthy children in the control group. After 12 months of the treatment, there were statistic differences within observation group in height standard deviation score(HtSDS), body weight, bone age, and growth rate(F = 2.730, 9.510, 6.010 and 52.250 respectively, all P<0.05), showing an ascending trend, and in bone metabolism indexes such as bone-specific alkaline phosphatase(BAP), osteocalcin(OC), procollagen type I N-terminal propeptide(PINP), insulin-like growth factor 1(IGF-1), and speed of sound(SOS) as distal radius bone mass there were significant differences within groups after treatment(F = 49.900, 10.480, 19.760, 77.960 and 3.310 respectively, all P<0.05), while no significant difference in the serum level of 25-hydroxyvitamin D3 25-(OH)D3] before and after treatment(P>0.05). Further comparison of the indexes at 3 months, 6 months and 12 months of the treatment showed that there were increasing trends in the serum levels of BAP, OC, PINP and IGF-1, while there was a decreasing tend in SOS. In blood glucose related indexes and thyroid function indexes there were no significant differences between the two groups before and after treatment(all P>0.05). In the observation group, 2 cases(5.00%) of skin redness, 1 case(2.50%) of headache, and 2 cases(5.00%) of impaired fasting insulin and fasting glucose during the treatment were found. Conclusion rhGH therapy for prepubertal children with ISS can effectively and safely promote growth and improve the bone metabolism, without any adverse effects on glucose metabolism and thyroid function.