重组人生长激素对生长激素缺乏症儿童骨代谢的影响

目的:研究生长激素缺乏症(GHD)儿童用生长激素治疗前后的骨代谢指标和骨量的改变.方法:测定37例完全性生长激素缺乏症(CGHD)、31例部分性生长激素缺乏症(PGHD)和31例年龄、性别匹配的正常健康儿童的血清骨代谢指标、类胰岛素生长因子1(IGF1)和桡骨远端超声传播速度(SOS),比较各组差异;同时对29例接受重组人生长激素(rhGH)治疗的GHD儿童3～6月定期复查.结果: CGHD组血清骨碱性磷酸酶(BAP)、Ⅰ型胶原交联羧基末端肽(ICTP)、IGF1显著低于正常对照组(P<0.05),ICTP与IGF1呈正相关(r=0.32,P=0.01);PGHD组IGF1低于正常对照组(P<0.05),其余各项指标与正常对照组比较无显著差异.GH治疗3月后BA P、ICTP、骨钙素(OC)和IGF1均显著高于基线值(P<0.05);ICTP和IGF1随治疗时间延长逐步增高.桡骨远端SOS SDS有增加趋势,但与基线值比较差异无显著性(P>0.05). 结论:CGHD儿童体内骨转换水平明显降低,桡骨远端骨量改变不明显;GH替代治疗半年后,骨形成和骨吸收指标明显增高,同时伴有骨量增加趋势.

Effects of recombinant human growth hormone (GH) replacement therapy on bone metabolism in children with GH deficiency

Objective: To study the changes of bone turnover markers and bone mass in children with growth hormone (GH) deficiency before and after recombinant human GH replacement therapy. Methods: Serum levels of bone turnover markers (OC,BAP and ICTP),IGF1 and distal radius bone mass (SOS SDS) of 37 cases with complete growth hormone deficiency (CGHD),31 partial growth hormone deficiency (PGHD) and 31 age- and sex-matched healthy controls were measured.Twenty-nine patients received rhGH replacement therapy at dose of 0.03 mg/kg.day and the above parameters were measured every 3 or 6 months after treatment. Results: Compared with the control,baseline serum levels of BAP,ICTP and IGF1 in CGHD group were significantly decreased (P<0.05),so was IGF1 in PGHD group (P<0.05).Significantly positive correlation was found between IGF1 and ICTP (r=0.32,P=0.01) in CGHD group.There was no significant difference between GHD group and the control in other biochemical parameters.All bone turnover markers and IGF1 increased significantly in both CGHD and PGHD children after rhGH replacement therapy for 3 months (P<0.05).ICTP and IGF1 were increasing with the prolonged rhGH replacement therapy.A tendency of increase in distal radius SOS SDS was also seen after rhGH(-treatment,)though not statistically significant (P>0.05). Conclusion: Compared with the control,bone turnover markers BAP and ICTP are lower in children with CGHD,with lower IGF1 but unchanged bone mass in both CGHD and PGHD.All bone turnover markers can be significantly improved in GHD children after rhGH replacement treatment for 6 months,with a tendency of increase in bone mass.