目的 探讨重组人生长激素(r-hGH)对特发性矮小(ISS)儿童的糖、脂代谢及甲状腺功能的影响.方法 选取2009年1月至2013年1月应用r-hGH治疗并定期随访的ISS儿童47例,年龄为10±3岁,治疗期限为3~24个月,随访间隔为每3个月1次,检测治疗后0~1年及治疗后1~2年时的空腹血糖、胰岛素、血脂、甲状腺功能等指标的变化.结果 r-hGH治疗后,患儿空腹血糖、胰岛素水平、胰岛素敏感指数、空腹血糖/胰岛素比值(FGIR)与治疗前比较差异无统计学意义,但FGIR有下降趋势;FGIR<7(提示胰岛素抵抗)的患儿治疗前为13%(6/47),治疗后1~2年为18%(4/22).治疗后动脉粥样硬化指数较前下降,而总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白水平及BMI与治疗前比较差异无统计学意义.治疗前后甲状腺功能无明显变化.结论 r-hGH治疗ISS儿童是安全可靠的,可改善脂代谢,对甲状腺功能、空腹血糖、胰岛素水平无明显影响,但有胰岛素敏感性降低的可能.
Abstract
Objective To study the effects of recombinant human growth hormone (r-hGH) replacement therapy on glucose and lipid metabolism and thyroid function in children with idiopathic short stature (ISS). Methods Forty-seven ISS children with a mean age of 10±3 years treated between January 2009 and January 2013 were enrolled. All children underwent r-hGH replacement therapy for 3-24 months and were followed up once every 3 months. Fasting blood glucose (FBG), insulin (INS), blood lipids and thyroid function were measured before treatment and after 0-1 and 1-2 years of treatment. Results After treatment with r-hGH, there were no significant changes in FBG, INS, insulin sensitivity index (ISI), and FBG/ INS ratio (FGIR), but the FGIR showed a declining trend. The percentage of patients with FGIR<7 (a marker of insulin resistance) was 13% before treatment compared to 18% 1-2 years after treatment. The atherosclerosis index decreased after r-hGH treatment, but there were no significant changes in total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and BMI. Furthermore, no significant change in thyroid function was observed after r-hGH therapy. Conclusions r-hGH therapy can improve lipid metabolism, without significant impacts on thyroid function, FBG and INS. It seems to be a safe and reliable therapy for children with ISS. However, this therapy possibly reduces insulin sensitivity.
关键词
重组人生长激素 /
特发性矮小 /
糖代谢 /
脂代谢 /
甲状腺功能 /
儿童
Key words
Recombinant human growth hormone /
Idiopathic short stature /
Glucose metabolism /
Lipid metabolism /
Thyroid function /
Child
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参考文献
[1] 颜纯, 王慕逖. 小儿内分泌学[M]. 北京: 人民卫生出版社, 2006: 91-132.
[2] Kemp SF, Frindik JP. Emerging opTions in growTh hormone Therapy: an updaTe[J]. Drug Des Devel Ther, 2011, 5(1): 411-419.
[3] 肖靖, 田慧, 李春霖, 等. 高胰岛素血症与正常胰岛素血症糖耐量低减人群转归差异的探讨[J]. 中华内科杂志, 2012, 51(4): 299-303.
[4] Frindik JP, Kemp SF. Managing idiopaThic shorT sTaTure: role of somaTropin (rDNA origin) for injecTion[J]. Biologics, 2010, 4(1): 147-155.
[5] Harvey S. ExTrapiTuiTary growTh hormone[J]. Endocrine, 2010, 38(3): 335-359.
[6] GoThersTrom G, BengTsson BA, Sunnerhagen KS, eT al. The effecTs of five-year growTh hormone replacemenT Therapy on muscle sTrengTh in elderly hypopiTuiTary paTienTs[J]. Clin Endocrinol (Oxf), 2005, 62(1): 105-113.
[7] BurgerT TS, Vuguin PM, DimarTino-Nardi J, eT al. Assessing insulin resisTance: applicaTion of a fasTing glucose To insulin raTio in growTh hormone-TreaTed children[J]. Horm Res, 2002, 57(1-2): 37-42.
[8] Quigley CA, Gill AM, Crowe BJ, eT al. SafeTy of growTh hormone TreaTmenT in pediaTric paTienTs wiTh idiopaThic shorT sTaTure[J]. J Clin Endocrinol MeTab, 2005, 90(9): 5188-5196.
[9] CuTfield WS, WilTon P, Bennmarker H, eT al. Incidence of diabeTes melliTus and impaired glucose Tolerance in children and adolescenTs receiving growTh-hormone TreaTmenT[J]. LanceT, 2000, 355(9204): 610-613.
[10] Lebrun P, Van Obberghen E. SOCS proTeins causing Trouble in insulin acTion[J]. AcTa Physiol (Oxf), 2008, 192(1): 29-36.
[11] Ho KK. Consensus guidelines for The diagnosis and TreaTmenT of adulTs wiTh GH deficiency II: a sTaTemenT of The GH Research SocieTy in associaTion wiTh The European SocieTy for PediaTric Endocrinology, Lawson Wilkins SocieTy, European SocieTy of Endocrinology, Japan Endocrine SocieTy, and Endocrine SocieTy of AusTralia[J]. Eur J Endocrinol, 2007, 157(6): 695-700.
[12] Louveau I, GondreT F. RegulaTion of developmenT and meTabolism of adipose Tissue by growTh hormone and The insulin-like growTh facTor sysTem[J]. DomesT Anim Endocrinol, 2004, 27(3): 241-255.
[13] 傅春江, 何作云, 王旭开, 等. 重组生长激素对兔冠状动脉粥样硬化的影响[J]. 重庆医学, 2008, 37(6): 572-573.
[14] Hannon TS, Danadian K, Suprasongsin C, eT al. GrowTh hormone TreaTmenT in adolescenT males wiTh idiopaThic shorT sTaTure: changes in body composiTion, proTein, faT, and glucose meTabolism[J]. J Clin Endocrinol MeTab, 2007, 92(8): 3033-3039.
[15] Seminara S, STagi S, Candura L, eT al. Changes of Thyroid funcTion during long-Term hGH Therapy in GHD children. a possible relaTionship wiTh caTch-up growTh?[J]. Horm MeTab Res, 2005, 37(12): 751-756.
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