重组人生长激素配合综合干预治疗特发性矮小症患儿疗效分析

发布时间：2018-03-31 03:19

  本文选题：特发性矮小症　切入点：重组人生长激素　出处：《浙江大学》2017年硕士论文

【摘要】：目的特发性矮小症ISS(idiopathic short stature)是一种以目前的医疗手段尚未找到明确病因,生长不足或身材矮小的疾病,占矮小患者的比例约为40%,是儿童矮小最常见的类型。矮小身材给特发性矮小症(ISS)儿童带来一系列社会和心理等方面的不良影响,改善特发性矮小症患儿的成年终身高以及缓解由于身材矮小所造成的心理压力,提高患儿的生活质量是治疗ISS的最终目的。目前临床上对特发性矮小的治疗方式主要有西医治疗和中医治疗。西医运用重组人生长激素(recombinant human growth hormone rhGH)进行治疗;中医治疗主要是采用基于脾虚,肾虚,脾肾两虚证型的健脾益肾中药方进行治疗。相比中医治疗,生长激素治疗在正确选择适应症的范围内效果显著,尤其体现在在生长激素治疗第一年。本研究探讨特发性矮小症(ISS)患儿经重组人生长激素(rhGH)结合综合干预治疗后生长发育的情况和各项生化指标的变化来评估其促进生长的疗效以及监测其安全性并为调整用药剂量提供依据;并与中医治疗的效果进行比较,探寻有效的,安全的,个性化的,经济的治疗方案。方法采用随机数字表法将63例确诊为特发性矮小症(ISS)患儿分为三组:将2011年7月到2012年10月在某附属体育医院生长发育门诊确诊但未采取治疗措施的18例ISS患儿分为未治疗组,采用皮下注射重组人生长激素治疗的25例ISS患儿为治疗I组,使用中药治疗的20例ISS患儿为治疗Ⅱ组,两治疗组结合综合干预。三组患儿观察时间均为12个月。记录治疗前患儿一般资料与治疗6个月及12个月后生长发育情况即身高,体重,骨龄以及各项生化指标的变化,生化指标包括:甲状腺功能(T3、T4、F T3、FT4、TSH),肝肾功能(ALT、AST、GGT、CRE、UREA),空腹血糖(FBG),胰岛素样生长因子1(IGF-1),胰岛素样生长因子结合蛋3(IGF-BP3)。结果三组特发性矮小症(ISS)患儿一般资料(性别、年龄、骨龄、体重、身高,基础生长激素)比较无统计学差异(P0.05)。两治疗组经治疗6个月和12个月后身高与未治疗组比较差异有统计学意义(P0.05);治疗12个月后,治疗I组年生长速率显著大于治疗Ⅱ组,两治疗组均大于未治疗组(P0.05)。两治疗组治疗12个月后年骨龄变化量未见有统计学意义(P0.05),未见骨龄提前。两治疗组体重增加均大于未治疗组,两治疗组之间比较无显著性差异(P0.05),体重指数BMI均在正常范围内。两治疗组IGF-1、IGF-BP3浓度较治疗前显著增加(P0.05),未见超过2SD。甲状腺功能(T3、T4、F T3、FT4、TSH),肝肾功能(ALT、AST、GGT、CRE、UREA)空腹血糖(FBG)较治疗前的差异无统计学意义(P0.05)。结论一年内在治疗ISS患儿方法中,重组人生长激素治疗结合综合干预促生长疗效显著并优于中药治疗组,IGF-1、IGF-BP3浓度较治疗前显著增加但未超过2SD,说明了治疗的有效性以及治疗剂量的合理性;骨龄未见提前,甲状腺功能和空腹血糖未见异常,证明了药物使用的安全性。
[Abstract]:Objective: idiopathic short stature ISS (idiopathic short stature) is a kind of current medical treatment has not yet found a clear cause, growth deficiency or short stature disease accounted for about 40% of the patients with short stature, is the most common type of children with short stature. Short stature to idiopathic short stature syndrome (ISS) adverse the influence of a series of social and psychological aspects of children, improvement in children with idiopathic short stature of the final adult height and alleviating the short stature caused by psychological pressure, improve the quality of life of children is the ultimate goal of treatment of ISS. The clinical treatment of idiopathic short stature are the main treatment of Western medicine and traditional Chinese medicine. Western medicine using recombinant human growth hormone (recombinant human growth hormone rhGH) treatment; Chinese medicine treatment is mainly based on the spleen, kidney, spleen and kidney deficiency type two prescription of invigorating spleen and tonifying kidney in the treatment phase. Compared with traditional Chinese medicine treatment, growth hormone treatment in the correct selection of indications within the scope of the effect is significant, especially in the first year of growth hormone therapy. The study of idiopathic short stature (ISS) in children with recombinant human growth hormone (rhGH) changes development combined with comprehensive intervention treatment and epigenetic biochemical indexes to to evaluate the curative effect and promote the growth of the safety monitoring and provide the basis for the adjustment of the dose; and compared with the traditional Chinese medicine treatment effect, explore effective, safe and personalized treatment plan, economy. Methods 63 patients diagnosed with idiopathic short stature with the random number table method (ISS) in children divided into three groups: July 2011 to October 2012 growth in an affiliated sports hospital development clinic diagnosed but did not take treatment measures in 18 cases with ISS were divided into untreated group, by subcutaneous injection of recombinant human growth hormone therapy 鐨，

本文编号：1688916