重组人生长激素治疗青春期早期特发性矮身材疗效观察及对骨代谢的影响

发布时间：2018-06-25 10:05

本文选题：特发性矮身材 + 重组人生长激素　；参考：《承德医学院》2017年硕士论文

【摘要】：目的:本研究以青春期早期特发性矮身材儿童为研究对象,以骨钙素、维生素D、胰岛素样生长因子-I等为研究指标,评价青春期骨生长情况,观察重组人生长激素对骨代谢的影响,探讨预测青春期ISS患儿疗效的监测指标;以身高、生长速率、骨龄等为评价指标,观察重组人生长激素对青春期早期ISS患儿身高的促进作用,探讨重组人生长激素治疗对青春期早期ISS患儿终身高是否有益。方法:从2014年12月起至2016年12月期间,将就诊于我院内分泌科并确诊为特发性矮身材的青春期早期患儿55例纳入随访,同时给予饮食、运动、睡眠等合理指导并定期随访,随访时间12个月。根据治疗与否分为治疗组(26例)与未治疗组(29例),并以青春期早期健康儿童作为对照组(25例)。严格执行纳入排出标准,收集入组儿童随访开始时的年龄、性别、身高、骨龄、胰岛素样生长因子-I、维生素D、骨钙素、性激素等基本数据信息;收集ISS患儿父母的身高情况;收集随访第3月、6月、9月、12月的身高、体重测量数据,IGF-I、骨钙素的检测数据;第6月、12月的骨龄、维生素D的检查检测结果。计算身高标准差分值、遗传靶身高及治疗12月后的生长速率。采用SPSS19.0统计软件进行数据分析,两样本比较采用t检验,多样本比较采用方差分析,以P0.05为差异有统计学意义,比较三组儿童性激素水平、骨代谢指标、生长速率、骨龄的变化。结果:(1)三组儿童随访开始时睾酮/雌激素、促卵泡生成素、促黄体生成素水平比较差异均无统计学意义(男F=0.50,0.39,0.03;女F=0.48,0.14,0.99,P0.05)。治疗组/未治疗组ISS患儿维生素D水平与对照组比较差异均无统计学意义,P0.05(男22.68±12.81/20.52±11.60 VS 23.62±11.90F=0.41;女21.05±12.71/21.20±11.74 VS 22.35±12.26 F=0.05),但治疗组/未治疗组ISS患儿OC及IGF-I水平较对照组均显著降低,比较差异均有统计学意义,P0.05(OC水平:男89.11±23.70/97.83±22.57 VS134.88±34.59,F=9.41;女91.20±24.56/98.67±25.38 VS 136.58±38.22,F=9.18)(IGF-I水平:男43.05±46.88/147.69±53.24 VS 195.50±58.16,F=3.51;女155.50±58.53/156.97±52.33 VS 211.34±61.38,F=4.28)。(2)治疗1个月时,rh GH治疗可使IGF-I明显升高,与未治疗组比较差异具有统计学意义(P0.05)。治疗1月后IGF-I明显升高,之后稍有下降,治疗6月时,治疗组IGF-I(男228.88±52.84 VS 180.73±50.85;女223.40±50.76 VS 178.40±54.91)、骨钙素水平(男153.44±38.43 VS120.04±31.77;女154.15±35.30 VS 119.67±32.93)与未治疗组比较明显升高,差异有统计学意义,P0.05。治疗1年后,骨龄有所变化,两组骨龄差值(△BA)比较,差异无统计学意义;(3)随访1年中,所有入组儿童IGF-I呈持续增高趋势,rh GH治疗组较未治疗组偏高。骨钙素水平亦明显升高。(4)两组ISS患儿生长速率均逐渐增加,至随访结束,两组ISS患儿Ht SDS比较差异无统计学意义,P0.05,但未治疗组患儿身高平均增加(0.18±0.14)SD,治疗组患儿身高平均增加(0.38±0.09)SD,相比治疗前,两组△Ht SDS差异具有统计学意义,P0.05。(5)随访治疗的16例ISS患儿中,经rh GH治疗后均无血、尿常规、肝肾功能、血糖、腹部脏器彩超检查的异常。发生膝关节疼痛1例,亚临床甲减1例,无过敏、视力下降、头痛等副作用发生。结论:(1)与健康儿童相比,青春期早期ISS患儿成骨细胞呈低代谢状态,生长速率偏低,骨生长落后;(2)重组人生长激素可促进青春期早期ISS患儿体内IGF-I、OC的生成增加,骨合成指标升高,加快骨形成,促进骨生长;(3)骨钙素水平能较好的反应生长速率,是rh GH治疗青春期ISS患儿疗效的良好监测指标;(4)重组人生长激素治疗青春期早期特发性矮身材儿童,可促进生长速率增加,短期内对骨龄无影响;可使终身高增加,但获益有限。
[Abstract]:Objective: in this study, early adolescent idiopathic short stature children were studied with osteocalcin, vitamin D, and insulin-like growth factor -I as research indicators to evaluate the growth of bone in puberty, observe the effect of recombinant human growth hormone on bone metabolism, and explore the monitoring indexes for predicting the curative effect of children with ISS in puberty, and the height and growth rate, The effect of recombinant human growth hormone (GH) on the height of ISS children in early puberty was observed and the effect of recombinant human growth hormone therapy on the final height of early puberty in children with ISS was investigated. 55 cases of early stage children were followed up, while diet, exercise, sleep and other reasonable guidance were given and followed up for 12 months. According to the treatment or not, the treatment group (26 cases) and the untreated group (29 cases), and the early puberty healthy children as the control group (25 cases), were strictly enforced into the discharge standard and collected into the group of children to follow up the follow up. The basic data of age, sex, height, bone age, insulin-like growth factor -I, vitamin D, osteocalcin, sex hormone, and other basic data were collected; the height of the parents of children with ISS was collected; the height, weight measurement data, IGF-I, and osteocalcin were collected for third months, June, September, December, and the results of sixth months, December bone age, and vitamin D examination results The standard difference of height, height of genetic target and the growth rate after December were calculated. The data were analyzed by SPSS19.0 software. The two samples were compared with t test. The variances were analyzed by variance analysis, and the difference of P0.05 was statistically significant. The changes of the level of sex, bone metabolism, growth rate and bone age of the three groups were compared. Results: (1) there was no significant difference in testosterone / estrogens, follicle stimulating hormone and luteinizing hormone levels in the three groups of children (male F=0.50,0.39,0.03, F=0.48,0.14,0.99, P0.05). There was no significant difference in vitamin D between the treatment group / untreated group of ISS and the control group, P0.05 (male 22.68 + 12.81/20.52). 11.60 VS 23.62 + 11.90F=0.41, female 21.05 + 12.71/21.20 + 11.74 VS 22.35 + 12.26 F=0.05, but the level of OC and IGF-I in ISS children in the treatment group / untreated group were significantly lower than those in the control group, and the difference was statistically significant. P0.05 (OC level: male 89.11 + 23.70/97.83 + 22.57 VS134.88 34.59, 91.20 + 91.20 + 25.38 + 136.5) 8 + 38.22, F=9.18) (IGF-I level: male 43.05 + 46.88/147.69 + 53.24 VS 195.50 + 58.16, F=3.51; female 155.50 + 58.53/156.97 + 52.33 VS 211.34 + 61.38, F=4.28). RH GH treatment can make IGF-I increase, and there is a significant difference with the untreated group (P0.05). After January, the treatment significantly rises, then a slight decline. In June, the treatment group IGF-I (228.88 + 52.84 VS 180.73 + 50.85; female 223.40 + 50.76 VS 178.40 + 54.91), osteocalcin level (male 153.44 + 38.43 VS120.04 + 31.77, and 154.15 + 35.30 VS 119.67 + +) were significantly higher than those in the untreated group, and the difference was statistically significant. The bone age difference was changed after P0.05. treatment. There was no statistically significant difference in Delta BA. (3) in the 1 year follow-up, all the children in the group had a continuous increase in IGF-I, and the RH GH treatment group was higher than the untreated group. (4) the growth rate of the two groups of ISS children increased gradually, to the end of the follow-up, there was no statistical difference between the two groups of ISS children with Ht SDS, P0.05, but not treated. The average height of the children in the group increased (0.18 + 0.14) SD, and the average height of the children in the treatment group increased (0.38 + 0.09) SD. Compared with the two groups before the treatment, the difference in the delta Ht SDS was statistically significant. In 16 cases of ISS children with P0.05. (5) follow-up treatment, there were no blood, urine routine, liver and kidney function, blood glucose, abdominal organ color Doppler ultrasonography after RH GH. 1 cases of pain and 1 subclinical hypothyroidism, no anaphylaxis, loss of vision, headache and other side effects. Conclusion: (1) compared with healthy children, the osteoblasts of early puberty ISS children showed low metabolic state, low growth rate, and backward bone growth. (2) recombinant human growth hormone could promote the formation of IGF-I, OC and bone synthesis in the early puberty of children. The index increases, accelerate bone formation, promote bone growth; (3) osteocalcin level can better respond to growth rate, is a good monitoring index of the effect of RH GH in the treatment of puberty ISS children; (4) recombinant human growth hormone treatment of early adolescent idiopathic short stature children, can promote growth rate, no effect on bone age in the short term; can make life-long increase Add, but the benefit is limited.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.8

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