rhGH治疗儿童矮小症促身高增长影响因素的研究

发布时间：2018-02-01 00:29

  本文关键词： 生长激素缺乏症 特发性矮小 重组人生长激素治疗 胰岛素样生长因子-1 胰岛素样结合蛋白-3　出处：《天津医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：1.比较国产重组人生长激素(recombinant human growth hormone, rhGH)对生长激素缺乏症(growth horomone deficiency, GHD)患儿和特发性矮小症(idiopathic short stature, ISS)患儿促身高线性生长的治疗效果。 2.观察rhGH治疗过程中血清胰岛素样生长因子-1(insulin-like growth factor1, IGF-1),胰岛素样结合蛋白-3(insulin-like growth factor binding protein3, IGFBP-3),甲状腺激素(thyroid hormone, TH)以及空腹血糖(fasting blood glucose, FBG)的变化。 3.分析临床上可能影响rhGH促身高线性生长治疗效果的因素。方法：选择就诊于天津医科大学总医院儿童内分泌门诊并经过rhGH治疗的矮小症患儿45例(GHD患者29例,ISS患者16例),治疗剂量为GHD0.10IU/(kg.d), ISS0.15IU/(kg.d),每晚睡前皮下注射。收集其中30例矮小病人的治疗前及治疗后每隔3个月随诊时的血清(其中GHD患者16例,ISS患者12例)。病例均于治疗后每隔3个月进行随诊,收集病例的临床资料,详细采集病史,进行全面的体格检查,测量患儿身高(height, Ht),体重(weight, Wt),检测FBG,游离三碘甲腺原氨酸(free three iodine armour gland original acid, FT3),游离甲状腺素(free thyroxine, FT4),促甲状腺素(thyroid-stimulating hormone, TSH)等生化指标,检测骨龄(bone age, BA),进行生长激素激发试验,头颅核磁共振等检查。计算体质指数(body mass index, BMI)、身高标准差积分(height standard deviation of points, HtSDS),生长速率(growth velocity, GV),父母遗传中位身高(mid-parental height, MPH),骨龄落后程度(BA-CA),骨龄成熟度(BA/CA)等指标。用化学发光法检测血清IGF-1, IGFBP-3.采用SPSS17.0统计软件,比较GHD (ISS)(?)台疗前、后的生长参数(Ht,HtSDS,GV,BA/CA,BMI)变化以及血清生化指标(IGF-1, IGFBP-3, FT3, FT4, TSH, FBG)变化；比较治疗0-3个月与治疗3-6个月的生长参数(△Ht,GV);比较两组(GHD与ISS)的治疗3个月的生长速率(GV3),治疗6个月的生长速率(GV6)；采用Pearson相关分析方法,分析GV3、GV6与实际年龄(chronological age, CA),开始治疗时的Ht, HtSDS, BA, BA-CA,生长激素激发试验峰值(GH峰值),MPH,IGF-1, IGFBP-3, FT3, GH剂量等临床指标的相关关系。P0.05有统计学意义。 结果：1.GHD和ISS患儿治疗3、6个月的Ht,HtSDS, GV均较治疗前升高,差异有统计学意义(P0.05或P0.001),治疗3、6个月的BMI稍有增加,但差异无统计学意义(P0.05),治疗3、6个月的BA/CA差异无统计学意义(P0.05)。 2.GHD和ISS患儿治疗0-3个月的△Ht,GV高于治疗3-6个月,但差异无统计学意义(PO.05)。 3.GHD组GV3,GV6均高于ISS组,差异有统计学意义(P0.05或P0.001)。 4.GHD与ISS组治疗前与治疗3、6个月的IGF-1,IGFBP-3水平成递增趋势,差异具有统计学意义(P0.05)。 5.GHD, ISS两组治疗后的FT3均较治疗前升高,FT4较治疗前下降,差异有统计学意义(P0.05), TSH的变化无统计学意义(P0.05),FBG较治疗前升高差异有统计学意义(P0.05)。 6.GHD组GV3与GH峰值(r=-0.42,P=0.02)成负相关；GV6与治疗前FT3(r=0.38,P=0.04), GV3(r=0.52,P=0.004)成正相关,与治疗前HtSDS (r=-0.55, P=0.002),GH峰值(r=-0.38,P=0.04)成负相关。ISS组GV3与治疗前Ht(r=-0.55, P=0.03),治疗前HtSDS(r=-0.51,P=0.04),治疗前BA(r=-0.55,P=0.03), IGFBP-3(r=-0.79, P=0.003)成负相关；GV6与GV3(r=0.64,P=0.01)成正相关,与治疗前BA (r=-0.55, P=0.03), BA-CA (r=-0.54, P=0.03)治疗前HtSDS (r=-0.64, P=0.01)成负相关。 7.GHD组IGF-1与治疗前FT3(r=0.57,P=0.02)、治疗3个月的FT3(r=0.57,P=0.02)成正相关；ISS组IGF-1与治疗前的FT3(r=0.63,P=0.03)成正相关。 结论：1.国产rhGH短期治疗可以有效改善GHD及ISS患儿身高,而且前3个月的治疗效果较好。与ISS相比,rhGH治疗对GHD患儿身高增长更明显。国产rhGH短期治疗不会加速BA成熟。 2.治疗过程中GHD, ISS患儿的FBG,FT3,FT4,IGF-1,IGFBP-3都有显著变化,是监测疗效和观察副作用的关键指标,应该在治疗期间积极动态监测。 3.与GHD患儿的GV3相关因素为：GH峰值；与GV6相关的因素为：治疗前FT3,治疗前HtSDS, GV3,峰值。与ISS患儿的GV3相关因素为：治疗前Ht,治疗前HtSDS,治疗前BA,治疗前IGFBP-3;与GV6相关的因素为：GV3,治疗前BA, BA-CA,治疗前HtSDS.
[Abstract]:Objective : To compare the therapeutic effects of recombinant human growth hormone ( rhGH ) on growth hormone deficiency ( GHD ) and idiopathic short stature ( ISS ) in children with growth hormone deficiency ( ISS ) . 2 . The changes of serum insulin - like growth factor 1 ( IGF - 1 ) , insulin - like growth factor binding protein 3 ( IGF - 1 ) , thyroid hormone ( TH ) and fasting blood glucose ( FBG ) were observed during rhGH treatment . Methods : Forty - five patients ( 29 patients with GHD and 16 ISS ) treated with rhGH were selected from 45 patients ( 29 patients with GHD patients and 16 ISS patients ) who were treated with rhGH . The therapeutic doses were GHD0.10 IU / ( kg 路 d ) and ISS0.15IU / ( kg 路 d ) . Serum of 30 cases of short patients before and after treatment ( 16 patients with GHD patients and 12 ISS patients ) were collected . The indexes such as body mass index ( BMI ) , height standard deviation of points ( FT3 ) , free thyroxin ( FT4 ) and thyroid - stimulating hormone ( TSH ) were measured . The growth parameters ( Ht , HtSDS , GV , BA / CA , BMI ) and serum biochemical indexes ( IGF - 1 , IGFBP3 , FT3 , FT4 , TSH , FBG ) were compared between 0 - 3 months and 3 - 6 months ( GV3 ) . Results : 1 . The Ht , HtSDS and GV were higher in the patients with GHD and ISS than before treatment ( P0.05 or P0.001 ) , but there was no significant difference in BMI between 3 and 6 months ( P0.05 ) . There was no significant difference in BA / CA in 3 and 6 months ( P0.05 ) . 2.GHD and ISS children treated for 0 - 3 months 鈻，

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