基础医学与临床 ›› 2019, Vol. 39 ›› Issue (10): 1455-1459.

• 研究论文 • 上一篇    下一篇

矮小症患儿生长激素激发试验与治疗反应的相关性

袁仙仙1,柯晓安1,苗卉1,阳洪波2,王林杰2,陈适2,杨莹莹1,龚凤英3,朱惠娟4,潘慧4   

  1. 1. 北京协和医学院
    2. 中国医学科学院 北京协和医学院 北京协和医院
    3. 北京协和医院内分泌科
    4. 北京协和医院
  • 收稿日期:2018-12-14 修回日期:2019-03-25 出版日期:2019-10-05 发布日期:2019-09-25
  • 通讯作者: 潘慧 E-mail:panhui20111111@163.com
  • 基金资助:
    中国医学科学院医学与健康科技创新工程;国家自然科学基金

Growth hormone provocation tests and the response to growth hormone in short stature

  • Received:2018-12-14 Revised:2019-03-25 Online:2019-10-05 Published:2019-09-25

摘要: 目的 分析生长激素缺乏症(GHD)和特发性矮小症(ISS)患者生长激素激发试验结果,及其与重组人生长激素(rhGH)治疗反应之间的关系。方法 回顾性分析36例GHD和24例ISS左旋多巴和胰岛素低血糖生长激素激发试验结果,rhGH治疗后身高增长情况,进行相关性分析。结果 GHD组两种激发试验峰值、曲线下面积(area under curve, AUC)与身高标准差比值(SDS)呈正相关(P < 0.001),校正性别、年龄、骨龄、体质SDS后,左旋多巴激发试验峰值及AUC与身高SDS仍呈正相关(r 0.471和0.427,P < 0.05);ISS组并无此相关性。两组治疗前身高SDS无差异,治疗第2年GHD组身高SDS显著高于ISS组(P < 0.05)。两组治疗后GV均明显增加,但治疗第2年GV较第1年有所下降。GHD组治疗第1年GV与治疗前两种激发试验峰值、AUC呈负相关,而ISS组并无相关性。结论 rhGH可显著改善GHD和ISS患儿身高,但随着治疗的延长GV有下降趋势;治疗前GH激发试验可一定程度预测GHD患儿rhGH治疗效果,但不能预测ISS患儿rhGH治疗效果。

关键词: 矮小症, 生长激素激发试验, 生长激素缺乏症, 特发性矮小症

Abstract: Objective To analyze the results of growth hormone provocation tests and its relationship with the response to recombinant human growth hormone (rhGH) in short stature. Methods Thirty-six growth hormone deficiency (GHD) patients and 24 idiopathic short stature patients who completed levodopa and insulin GH provocation test were analyzed retrospectively. The height during rhGH treatment was collected and correlation analysis was conducted. Results In the GHD group, there was a positive correlation between the peaks and area under curve (AUC) of the two GH provocation tests and height SDS (P < 0.001). After adjusting for gender, age, bone age and weight SDS, the positive correlation between the peak and AUC of L-DOPA provocation test and height SDS still existed (r 0.471 and 0.427, respectively, P < 0.05). But such correlation was not found in the ISS group. The height SDS and GV of both groups increased significantly after rhGH treatment, and height SDS of GHD was significantly higher than that of ISS at the second year of treatment. However, GV in the second year of treatment decreased compared with that in the first year of treatment. Correlation analysis showed that GV in the first year of treatment in GHD group was negatively correlated with the peak value and AUC of GH provocation tests, while this was not found in ISS group. Conclusions rhGH can significantly improve the height of patients with GHD and ISS, but the GV decreased as the time of treatment increased. GH provocation tests can predict the therapeutic effect of rhGH in GHD children, but those cannot predict the therapeutic effect of rhGH in ISS children.

Key words: shorth stature, growth hormone provocation tests, growth hormone deficiency, idiopathic short stature