Clinical effect of recombinant human growth hormone on the treatment of children with prepubertal growth hormone deficiency based on different body mass indexes

doi:10.11852/zgetbjzz2019-1125

Abstract

Abstract: Objective To explore the clinical effect of recombinant human growth hormone(rhGH) on treatment of children with prepubertal growth hormone deficiency(GHD) based on different body mass index(BMI),in order to provide basis for individualized treatment. Methods Totally 76 children with GHD accepting more than one year treatment of rhGH in Guangdong Women and Children′s Hospital from January 2016 to December 2018 were involved in this study.According to the BMI threshold of obesity and overweight published by China Obesity Task Group in 2004, children with GHD were divided into three groups:normal BMI group(30 cases), overweight group(23 cases) and obesity group(23 cases).Before and after treatment, height, BMI, bone age, insulin-like growth factor(IGF-1) and insulin-like growth factor-binding protein 3(IGFBP-3) levels were tested. Height velocity(HV), height standard deviation scores(HtSDS), fasting blood glucose, insulin, thyroid stimulating hormone(TSH), FT3, FT4 were measured. Results After one year of treatment, the HV and HtSDS of the three groups were significantly improved(P<0.05), and the therapeutic effect of the normal BMI group was better than that of the overweight and obesity group(P<0.05).There was no significant difference on treatment efficacy between the overweight and obesity group(P>0.05).The BMI of overweight and obesity group significantly decreased after treatment(P<0.05).Compared with those before treatment, fasting glucose, insulin, TSH, FT3 and FT4 levels did not show significant differences after treatment(P>0.05). Conclusionss RhGH can significantly improve the growth rate of GHD children in prepuberty.After correcting other factors, when rhGH is used to treat overweight and obese children with GHD, it is speculated that a larger dose of rhGH may be needed to obtain a better growth rate.

Key words: growth hormone deficiency, body mass index, curative effect analysis

摘要： 目的分析不同体重指数(BMI)的青春前期生长激素缺乏症(GHD)患儿采用重组人生长激素(rhGH)治疗的临床疗效,为实现rhGH的个体化治疗提供理论依据。方法选取2016年1月-2018年12月在广东省妇幼保健院接受rhGH治疗1年以上的76例GHD患儿为研究对象,依据中国肥胖问题工作组2004年发布的儿童肥胖、超重筛查BMI界值点,将GHD患儿分为BMI正常组(30例)、超重组(23例)和肥胖组(23例),治疗前、治疗1年后分别测定身高、BMI、骨龄及血清中胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白3(IGFBP-3)的含量,并计算生长速率(HV)、身高标准差积分(HtSDS),测定治疗前后空腹血糖、空腹胰岛素、促甲状腺激素(TSH)、FT3、FT4水平。结果 3组患儿治疗1年后的HV、HtSDS均较治疗前明显改善(P＜0.05),其中BMI正常组治疗效果优于超重组及肥胖组(P＜0.05),超重组与肥胖组的治疗效果相比差异无统计学意义(P＞0.05)。3组患儿治疗1年后BMI均有下降趋势,其中超重组、肥胖组与治疗前相比,差异有统计学意义(P＜0.05)。治疗1年后,3组患儿与治疗前相比,测定TSH、T3、T4、空腹胰岛素及空腹血糖等无异常改变。结论 rhGH可以显著提高青春前期GHD患儿的生长速率,在纠正了其他因素后,应用rhGH治疗超重、肥胖GHD患儿时,推测可能需要更大的rhGH剂量以获得更好的生长速度。

关键词: 生长激素缺乏症, 体重指数, 疗效分析

CLC Number:

R725.8

LIU Ying, LIU Cui, NING Jing, GUO Yong, WU Jie-ling. Clinical effect of recombinant human growth hormone on the treatment of children with prepubertal growth hormone deficiency based on different body mass indexes[J]. journal1, 2020, 28(4): 385-388.

刘瑛, 刘翠, 宁静, 郭勇, 吴婕翎. 基于不同体重指数的青春前期生长激素缺乏症患儿采用重组人生长激素治疗的疗效分析[J]. 中国儿童保健杂志, 2020, 28(4): 385-388.

References

[1] Stanley T.Diagnosis of growth hormone deficiency in childhood[J].Curr Opin Endocrinol Diabetes Obes,2012,19(1):47-52.
[2] Wang Q, Liu DY, Yang LQ, et al.The epidemic characteristics of short stature in school students[J].Ital J Pediatr,2015,41(99):2-6.
[3] Abarca-Gómez L, Abdeen Z, Hamid Z, et al.Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016:a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults[J].Lancet,2017,390(10113):2627-2642.
[4] Garten A, Schuster S, Kiess W.The insulin-like growth factors in adipogenesis and obesity[J].Endocrinol Metab Clin North Am,2012,41(2):283-295.
[5] 中国肥胖问题工作组.中国学龄儿童青少年超重、肥胖筛查体重指数分类标准[J].中华流行病学杂志,2004,25(2):97-102.
[6] 中华医学会儿科学分会内分泌遗传代谢学组,《中华儿科杂志》编辑委员会.基因重组人生长激素儿科临床规范应用的建议[J].中华儿科杂志,2013,51(6):426-432.
[7] Greulich WW, Pyle SI.Radiographic atlas of skeletal development of hand and wrist [M].2nd ed.Califonia:Stanford University Press,1959.
[8] 胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:23-38.
[9] Ranke MB.Pediatric growth hormonedeficiengcy(GHD) in the recombinant human GH(rhGH) Era[J].Pediatr Endocrinol Rev,2018,16(Suppl 1):63-69.
[10] Makimura H, Feldpausch MN, Stanley TL, et al.Reduced growth hormone secretion in obesity is associated with smaller LDL and HDL particle size[J].Clin Endocrinol(Oxf),2012,76(2):220-227.
[11] Miller GD,Nicklas BJ, Davis CC, et al.Basal growth hormone concentration increased following a weight loss focused dietary intervention in older overweight and obese women[J].J Nutr Health Aging,2012,16(2):169-174.
[12] Slattery M,Bredella MA, Stanley T, et al, Effects of recombinant human growth hormone(rhGH) administration on body composition and cardiovascular risk factors in obese adolescent girls[J].Int J Pediatr Endocrinol,2014,2014(1):22.
[13] 王慧,于立君.儿童肥胖症与生长激素、甲状腺激素关系的研究进展[J].疑难病杂志,2015,14(12):1316-1320.
[14] Marcovecchio ML, Chiarelli F.Obesity and growth during childhood and puberty[J].World Review of Nutrition and Dietetics,2013,106:135-141.
[15] Ricco RC, Ricco RG, Queluz MC,et al.IGF-1R mRNA expression is increased in obese children[J].Growth Hormone IGF Research,2018,39(4):1-5.
[16] Tanaka T,Yokoya S, Fujieda K, et al.Efficacy and safety of up to 8 years of long-term growth hormone treatment in short children born small for gestational age in Japan:analysis of the subpopulation according to the Japanese guideline[J].Clin Pediatr Endocrinol,2012,21(4):57-68.
[17] Witkowska-Sedek E, Borowiec A, Majcher A, et al.Thyroid function in children with growth hormone deficiency during long-term growth hormone replacement therapy[J].Cent Eur J Immunol,2018,43(3):255-261.
[18] Chang YC,Hua SC, Chang CH, et al.High TSH level within normal range Is associated with obesity, dyslipidemia, hypertension, inflammation, hypercoagulability, and the metabolic syndrome:a novel cardiometabolic marker [J].J Clin Med,2019,8(6):817.