重组人生长激素治疗青春期早期特发性矮小症对骨代谢的影响

目的:探讨青春期早期特发性矮小症患儿采用重组人生长激素治疗前后骨代谢的变化情况。方法:回顾性分析2016年2月至2017年2月我院接诊的80例青春期早期特发性矮小症患儿的临床资料,根据家长意愿分为治疗组45例和对照组35例。对照组由医师指导患儿合理饮食、适量运动、保证充足睡眠等,不给予药物治疗,治疗组在对照组治疗基础上给予重组人生长激素(rh GH)治疗,比较两组患儿随访12个月期间的生长情况、血清胰岛素样生长因子(IGF-1)、骨钙素(OC)、25羟维生素D25(OH)D]的变化情况,并记录治疗组的药物不良反应。结果:随访12个月时,两组患儿身高、骨龄均较随访前增加,且治疗组患儿的身高、身高标准差分值(Ht SDS)、年生长速度均大于对照组(P均<0. 01),但两组患儿骨龄比较差异无统计学意义(P>0. 05)。随访3个月、6个月、12个月时,两组患儿的血清OC、25(OH)D水平均逐渐升高(P均<0. 01),治疗组患儿的血清IGF-1、OC水平均高于对照组(P均<0. 05),两组患儿的血清25(OH)D水平比较差异无统计学意义(P> 0. 05)。在治疗过程中治疗组出现膝关节疼痛2例,给予热敷后好转;治疗6个月时出现亚临床甲状腺功能减退症1例,给予左甲状腺素钠替代治疗后1个月甲状腺功能恢复正常。结论:rh GH治疗青春期早期特发性矮小症效果显著,可有效促进患儿生长发育,短期内不影响骨龄,而通过对OC的检测可较好地反映生长速度,临床应用价值较高。

Effects of Recombinant Human Growth Hormone on Bone Metabolism in Children with Idiopathic Short Stature in Early Adolescence

Objective: To probe into the changes of bone metabolism in children with idiopathic short stature before and after treatment of recombinant human growth hormone (rhGH). Methods: The clinical data of 80 children with idiopathic short stature in early adolescence admitted to our hospital from Feb. 2016 to Feb. 2017 were retrospectively analyzed, and all patients were divided into the treatment group (n=45) and the control group (n=35) according to the intends of the children''s parents. The control group received reasonable diet, moderate exercise and adequate sleep, and no drug treatment; the treatment group was given rhGH treatment on the basis of the control group. Growth, serum insulin-like growth factor (IGF-1), osteocalcin (OC), and 25-hydroxyvitamin D (25(OH)D)were compared between two groups during a 12-month follow-up, and adverse drug reactions were recorded in the treatment group.Results: After 12 months of follow-up, the height and bone age of the children in both groups significantly increased compared with those before the follow-up, and the height, height standard deviation score (HtSDS) and annual growth rate of the treatment group were greater than those of the control group (P<0.01), but the difference of bone age between two groups was not statistically significant (P>0.05). At 3, 6 and 12 months of follow-up, the serum OC and 25 (OH) D levels were gradually increased in both groups (P<0.01), the serum IGF-1 and OC levels in the treatment group were higher than those in the control group (P<0.05), there was no significant difference of serum 25(OH)D levels between two groups (P>0.05). In the treatment group, 2 cases of knee joint pain occurred during the process of treatment, which had been improved after hot compress treatment, subclinical hypothyroidism occurred in 1 patient after treatment of 6 months, and the thyroid function returned to normal after levothyroidectomy treatment of 1 month. Conclusion: The rhGH is effective in the treatment of children with idiopathic short stature in early adolescence, which can effectively promote the growth and development, and does not affect bone age in the short term. The detection of OC can reflect the growth rate better and has higher clinical application value.