特发性矮身材临床相关因素观察

发布时间：2017-12-28 21:18

本文关键词：特发性矮身材临床相关因素观察　出处：《河南科技大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的了解儿童特发性矮身材(ISS)的临床相关因素;观察基因重组人生长激素(r-h GH)的临床疗效及安全性,探讨r-hGH的促生长疗效与血清胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)的关系。方法1.使用自拟“特发性矮身材儿童相关因素调查表”回顾性调查我院近4年诊治的ISS儿童144例,对临床相关因素进行描述性分析;2.选取接受rhGH治疗剂量为(0.15IU/kg·d)达12个月的ISS儿童67例,分别在治疗前及治疗后的每3个月测定身高、体重、空腹血糖、甲状腺功能、IGF-1及IGFBP-3等,治疗前及治疗后的每6个月测定骨龄,并使用自拟的“特发性矮身材儿童接受r-h GH治疗的随访表”进行记录;3.进行统计学处理:采取方差齐性检验、重复测量的方差分析、秩和检验及线性相关性分析等方法研究r-hGH的临床疗效、安全性及其促生长疗效与IGF-1、IGFBP-3的关系。结果1.描述性分析:(1)基本情况:144例患儿中男84例,女60例,性别比为1.4:1;年龄3~16岁,中位数9.1岁。就诊年龄:以6岁~11岁为主,占52.78%;农村儿童占44.44%;(2)父母情况:父亲身高P25~P50的占38.19%,身高≤P25的占33.33%;母亲身高P25~P50的占36.11%,身高≤P25的占43.05%;(3)ISS儿童生活习惯:入眠时间在11:30之后占47.22%;挑食、偏食占54.86%;每天运动量小于30min者占61.11%;2.ISS儿童接受r-hGH治疗后身高及生长速率较前提高,差异有统计学意义(P0.05);体重及骨龄未见明显快速增长,差异无统计学意义;不良反应发生率为17.91%,对症处理后均恢复正常。3.ISS儿童治疗3、6、9、12月的IGF-1及IGFBP-3均较治疗前增加,差异有统计学意义(P0.05);治疗前IGF-1及IGFBP-3与治疗后3月、6月、9月、12月的生长速率增加量呈负相关(P0.05);治疗后3月、6月、9月、12月IGF-1及IGFBP-3增加量与同期生长速率增加量均呈正相关。结论1.本调查中ISS儿童多来自农村;父母身高以中等偏下居多;父母受教育程度以初高中、职业以农民及个体户居多;存在不良饮食习惯、入眠时间在23:30以后、每日运动量小于30分钟者占多数;2.观察期内r-hGH治疗ISS疗效肯定,未发现严重影响患儿生活质量的安全性问题;3.IGF-1及IGFBP-3对预测r-h GH治疗ISS的疗效的有一定的价值。
[Abstract]:Objective to understand the children with idiopathic short stature (ISS) clinical related factors; effect of recombinant human growth hormone (R-H GH) the clinical efficacy and safety of r-hGH, the growth promoting effect of serum insulin-like growth factor -1 (IGF-1), insulin-like growth factor binding protein -3 (IGFBP-3) relationship. Methods 1. made by the related factors of idiopathic short stature children were retrospectively investigated in recent 4 years in our hospital diagnosis and treatment of 144 children with ISS were analyzed by descriptive analysis of clinical related factors; 2. were treated with rhGH doses (0.15IU/kg - D) for 12 months up to 67 children with ISS before treatment, respectively and after treatment every 3 months for measuring height and weight, fasting blood glucose, thyroid function, IGF-1 and IGFBP-3, before and after treatment every 6 months for determination of bone age, and use the self-made "idiopathic short stature children underwent R-H GH treatment follow-up table records; 3. were: take the test of homogeneity of variance, repeated measures ANOVA, rank sum test and linear correlation analysis were used to study r-hGH clinical efficacy, safety and growth promoting effect and IGF-1, IGFBP-3 relationship. Results 1. descriptive analysis: (1) the basic situation: 144 cases of children 84 cases, female 60 cases, sex ratio is 1.4:1; age 3~16 years, median 9.1 years. Age: 6 years old ~11 years old, accounting for 52.78%; rural children accounted for 44.44%; (2) parents: father height P25~P50 accounted for 38.19%, accounting for 33.33% of the height less than P25; height of mother P25~P50 accounted for 36.11%, accounting for 43.05% of the height is less than or equal to P25; (3) ISS children's life habit: sleep time accounted for 47.22% after 11:30; partial eclipse picky eaters, accounted for 54.86%; amount of exercise every day is less than 30min accounted for 61.11%; 2.ISS children treated with r-hGH height and the growth rate is increased, the difference was statistically significant (P0.05); no significant weight and bone age of rapid growth, the difference was not statistically significant; the incidence rate of adverse reaction was 17.91%, after symptomatic treatment. All returned to normal. IGF-1 and IGFBP-3 3.ISS, 6, 9 children in 3 and December were compared with those before treatment, the difference was statistically significant (P0.05); IGF-1 and IGFBP-3 before treatment and after treatment, the growth rate in March June and September December, the increase was negatively correlated (P0.05); March, June, September after treatment, December IGF-1 and IGFBP-3 increase with the same growth rate increase was positively correlated. Conclusion the 1. survey of ISS children from rural areas; parents height to moderate majority; parental education in junior high school and senior high school, occupation to the majority of farmers and self-employed; there are unhealthy eating habits, sleep time after 23:30, the daily amount of exercise for less than 30 minutes of majority; 2. in the observation period of r-hGH treatment of ISS curative effect no, seriously affect the safety of children's quality of life is found; 3.IGF-1 and IGFBP-3 have certain value in predicting the efficacy of the treatment of ISS R-H GH.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R725.8

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