rhGH单用或联合GnRHa治疗儿童和青春期矮身材的疗效及其对代谢变化的影响

发布时间：2018-04-23 15:47

  本文选题：重组人生长激素 + 促性腺激素释放激素类似物　； 参考：《北京协和医学院》2017年博士论文

【摘要】：背景和目的随着社会的发展,国民经济水平的提高,人们越来越重视对美的追求,身高作为美的重要方面,也受到越来越多的关注。由于矮身材对患者的自尊、生活、工作和婚恋造成诸多影响,儿童和青春期矮身材患者及其家属往往有强烈的改善身高的需求。应用重组人生长激素(rhGH)或联用促性腺激素释放激素类似物(GnRHa)治疗儿童和青春期矮身材的疗效尚有争议;对治疗过程中rhGH对糖代谢、脂代谢、甲状腺功能等方面的影响研究不多,对rhGH联合GnRHa治疗矮身材过程中患者的代谢变化所知甚少。本文旨在分析儿童和青春发育初期的矮身材患者采用rhGH单用或rhGH联合GnRHa治疗的疗效,以及治疗过程中的代谢变化。对象和方法rhGH单用或rhGH联合GnRHa治疗的儿童及青春期矮身材患者共62例。青春发育前的患者采用rhGH单用治疗;明显青春发育的患者采用rhGH联合GnRHa治疗;部分青春发育刚启动的患者,临床判断其青春发育速度较慢,生长潜力较大,结合患者及其家属的意愿等因素,也采用了 rhGH单用治疗。每隔3-6个月随诊一次,监测身高、空腹血糖、空腹胰岛素、血脂、甲状腺功能、肝酶等指标的水平。结果1.单用rhGH治疗前、治疗6个月、治疗12个月的HtSDSCA依次升高(p=0.001);但治疗前后HtSDSBA的差异大多无统计学意义;治疗后12个月PAH平均升高1.7cm。联合用药组治疗前、治疗6个月、治疗12个月的HtSDSCA和HtSDSBA依次升高,且具有统计学意义(p=0.022);治疗后12个月PAH平均升高6.4cm。2.单用 rhGH 组 FBG、FINS、HOMA-IR、TC、TG、HDL-C、TG/HDL-C 治疗前后的差异均无统计学意义;治疗后LDL-C降低(12个月p=0.043);ALT(6个月p=0.041)和AST(6个月p=0.028)有所降低;治疗后FT3升高(6个月p=0.020),FT4先下降,再升高(3个月p=0.014),治疗前后TSH的差异均无统计学意义。联合用药组治疗后FBG、FINS、HOMA-IR均升高(12个月FBG p=0.027;FINS p=0.028;HOMA-IRp=0.028);治疗后 TC、TG、LDL-C、HDL-C、TG/HDL-C 与治疗前的差异无统计学意义;治疗3个月后,ALT比治疗前升高(p=0.042),但尚在正常范围内,AST治疗前后无显著差异;FT3、FT4治疗前后的差异无统计学意义,治疗后9个月TSH降低(p=0.028)。3.对青春发育情况相似的单用和联用患者进行组间比较(n=20,单用组11例,联用组9例),治疗前HtSDSBA、PAH、IGF-1及各代谢指标相似。治疗后单用组IGF-1高于联用组(6个月p=0.018),GV高于联用组(3个月p=0.011),且GV与GnRHa使用与否显著相关,治疗后HtSDSBA和PAH组间差异无统计学意义;治疗后HOMA-IR、TG/HDL、ALT、AST、FT3、FT4、FT3/FT4 及 TSH 组间差异无统计学意义。结论单用rhGH或联合GnRHa治疗儿童和青春期矮身材,可提高PAH;青春发育初期短期治疗,两种方案疗效相当,对胰岛素敏感性、血脂、转氨酶、甲状腺功能的影响没有显著差异。
[Abstract]:With the development of society and the improvement of national economy, people pay more and more attention to the pursuit of beauty. Height, as an important aspect of beauty, is paid more and more attention. Because of the influence of short stature on patients' self-esteem, life, work and marriage, children and puberty short stature patients and their families often have a strong need to improve their height. The effect of recombinant human growth hormone (rhGH) or gonadotropin releasing hormone analogue (GnRHa) on short stature in children and puberty is still controversial, and the effects of rhGH on glucose metabolism, lipid metabolism and thyroid function are not studied. Little is known about metabolic changes in patients with short stature treated with rhGH and GnRHa. The purpose of this study was to analyze the efficacy of rhGH alone or rhGH combined with GnRHa in children and early puberty patients with short stature and the metabolic changes in the course of treatment. Participants and methods 62 children and puberty patients with short stature were treated with rhGH alone or rhGH combined with GnRHa. Patients before puberty development were treated with rhGH alone; those with obvious youth development were treated with rhGH combined with GnRHa; some patients who had just started youth development were clinically judged to have slower growth rate and greater growth potential. Combined with the wishes of patients and their families, rhGH alone was also used. The levels of height, fasting blood glucose, fasting insulin, blood lipid, thyroid function and liver enzyme were monitored every 3 to 6 months. Result 1. Before and after treatment with rhGH alone, HtSDSCA increased in turn after 6 months and 12 months, but there was no significant difference in HtSDSBA before and after treatment, and the average increase of PAH was 1.7 cm at 12 months after treatment. The HtSDSCA and HtSDSBA of the combined treatment group increased in turn after 6 months of treatment and 12 months of treatment, and were significantly higher than that of the control group, and the PAH increased by 6.4 cm 路2. 2 at 12 months after treatment. In rhGH group, there was no significant difference before and after treatment, LDL-C decreased (12 months, p0.043) and AST (6 months, p0.028) decreased, FT3 increased (6 months, p0.020) and FT4 decreased after treatment, and the difference was not statistically significant before and after treatment, but there was no significant difference before and after treatment, and the level of FT3 increased after 6 months (p 0.020), and decreased at 12 months after treatment (p 0.043) and AST (6 months, p0.041) and AST (6 months, p0.028), and increased after treatment (p 0.020% FT4, P < 0.05). There was no significant difference in TSH before and after treatment. In the combined treatment group, the FBGG FINSMA-IR increased (12 months after treatment, FBG p0. 027 and fins p0. 028, HOMA-IRP 0. 028), and there was no significant difference between the two groups before and after treatment. After 3 months of treatment, the level of alt was higher than that before treatment. However, there was no significant difference in TSH between before and after treatment in normal range. There was no significant difference between before and after treatment. After 9 months of treatment, TSH was decreased by 0.028. 3. A comparison was made between the two groups of patients with similar pubertal development. There were 11 cases in the single use group and 9 cases in the combined group. Before treatment, the levels of HtSDSBAPAHIGF-1 and the metabolic indexes were similar. After the treatment, the IGF-1 of the single group was higher than that of the combined group (6 months p0. 018) GV was higher than that of the combined group (3 months, p0. 011), and there was no significant difference between HtSDSBA and PAH after treatment, but there was no significant difference between the two groups after treatment. Conclusion rhGH alone or combined with GnRHa can improve the height of children and puberty, and the effects on insulin sensitivity, blood lipid, aminotransferase and thyroid function of the two regimens are similar in the early stage of puberty.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R725.8

【相似文献】

相关期刊论文 前10条

1 ;Bioequivalence Between rhGH for Reconstitution and Ready-to-Use rhGH in Two Liquid Formulations[J];上海交通大学学报(医学版);2006年03期

2 冉江华;郭永章;李立;张升宁;刘静;李铸;李来邦;;rhGH在大鼠肝脏缺血再灌注损伤中保护和修复的作用[J];肝胆外科杂志;2008年04期

3 张翼飞;杜鹏飞;徐敏;张毅;张连珍;王卫庆;赵咏桔;宁光;;BIOEQUIVALENCE BETWEEN rhGH FOR RECONSTITUTION AND READY-TO-USE rhGH IN TWO LIQUID FORMULATIONS[J];上海第二医科大学学报(外文版);2006年01期

4 马\~;王德全;崔行;胡晓燕;;rhGH的受体结合活性研究[J];山东医科大学学报;1991年02期

5 郝洪波,李秉寿,张秀清,王德昌;rhGH与烧伤[J];山东医药;2002年32期

6 张先林;吴遵元;丁志强;俞亚红;陈勇军;;rhGH联合应用谷氨酰胺对梗阻性黄疸患者术后免疫功能影响的研究[J];中国现代医学杂志;2009年11期

7 龚学东;李善平;张先林;吴遵元;陈季松;;rhGH对梗阻性黄疸患者术后免疫功能的影响[J];世界华人消化杂志;2009年17期

8 侯文婧;徐小薇;潘慧;;与rhGH促线性生长效应有关的候选基因及多态性位点筛选的研究进展[J];中国药学杂志;2011年10期

9 ;In vitro effects of recombinant human growth hormone on growth of human gastric cancer cell line BGC823 cells[J];World Journal of Gastroenterology;2004年08期

10 邹志强;翁钦永;;rhGH在12例机械通气困难脱机中应用的临床效果观察[J];福建医药杂志;2010年04期

相关会议论文 前10条

1 陈锦武;陈其奎;王凌云;于钟;钟娃;;重组生长激素(rhGH)对放射性小肠黏膜损伤的修复作用[A];第九次全国消化系统疾病学术会议专题报告论文集[C];2009年

2 李金玺;刘旭盛;唐辉;周新;黄跃生;;部分创面外用抗菌素与bFGF,EGF,rhGH对Hacat生物学特性影响[A];第六届全国烧伤救治专题研讨会论文汇编[C];2009年

3 沐雨;李苏宜;;人胃癌移植瘤组织GHR差异表达与rhGH促增殖效应变化[A];2014《中国国际肿瘤营养学论坛》暨第二届《全国肿瘤营养与支持治疗学术会议》论文汇编[C];2014年

4 刘明华;骆立荣;郑永宏;张载乐;;安苏萌(rhGH)在小儿中、重度烧伤病人中的临床应用观察[A];全国烧伤早期处理专题研讨会论文集[C];2002年

5 俞军;梁廷波;郑树森;徐世国;沈克霞;;rhGH对大鼠原位小体积肝移植术后肝脏再生的影响[A];2005年浙江省外科学术会议论文汇编[C];2005年

6 曲宏岩;张国强;庞达;赵龙滨;;重组生长激素(rhGH)在胃癌根治术中的应用[A];2000全国肿瘤学术大会论文集[C];2000年

7 邵华伟;陈国贤;韩春茂;;重组人生长激素(rhGH)对重度烧伤患者水钠潴留的影响[A];中华医学会第十一届全国营养支持学术会议论文汇编[C];2008年

8 李嫔;王斐;;GnRHa和rhGH联合治疗及治疗后单用rhGH治疗对大骨龄特发性中枢性性早熟患儿的身高改善差异[A];2012年江浙沪儿科学术年会暨浙江省医学会儿科学分会学术年会、儿内科疾病诊治新进展国家级学习班论文汇编[C];2012年

9 尚兴红;宋国栋;汤华林;马印东;辛乃军;贾军;张磊;;早期联合应用MEP和大剂量rhGH对严重烫伤大鼠肠源性感染的影响[A];第四届华东六省一市整形外科学术会议暨2007年浙江省整形、美容学术会议论文汇编[C];2007年

10 尚兴红;宋国栋;;早期联合应用MEP和大剂量rhGH对严重烫伤大鼠肠源性感染的影响[A];2005年全国中西医结合医学美容学术研讨会论文汇编[C];2005年

相关博士学位论文 前3条

1 梁爽;肥胖患儿GH-IGF-1轴改变与心血管危险因素相关性研究及rhGH治疗探讨[D];山东大学;2017年

2 熊舒煜;rhGH单用或联合GnRHa治疗儿童和青春期矮身材的疗效及其对代谢变化的影响[D];北京协和医学院;2017年

3 冉江华;rhGH对SD大鼠肝脏缺血再灌注损伤的保护及修复作用[D];昆明医学院;2006年

相关硕士学位论文 前10条

1 闫立论;重组人生长激素(rhGH)的毕赤酵母工程菌构建、表达、分离纯化及其生物学作用研究[D];河南师范大学;2015年

2 郑成然;rhGH治疗儿童生长激素缺乏症的疗效及对相关指标的影响[D];山东大学;2016年

3 崔志瑞;小剂量甲状腺素干预对特发性矮小患儿生长激素敏感性的影响[D];郑州大学;2016年

4 刘敬义;rhGH对大鼠肾脏缺血再灌注损伤保护作用的实验研究[D];昆明医学院;2009年

5 赵红川;前列腺素E1(PGE1)和重组人生长激素(rhGH)在肝脏缺血-再灌注损伤和肝切除中作用的实验研究[D];安徽医科大学;2001年

6 侯文婧;探讨影响中国汉族GHD患儿rhGH促线性生长效应的遗传及非遗传因素[D];中国协和医科大学;2010年

7 陈应果;rhGH上调MRP2表达及促胆红素转运的作用机制[D];第三军医大学;2003年

8 肖丽;rhGH对LPS诱导的巨噬细胞凋亡和NF-κB的影响[D];中南大学;2007年

9 崔敬茹;矮身材儿童生长激素受体外显子3基因多态性以及与rhGH疗效相关性分析[D];天津医科大学;2011年

10 王颖;rhGH治疗儿童矮小症促身高增长影响因素的研究[D];天津医科大学;2012年

，

本文编号：1792610