重组人生长激素在治疗慢性肾脏病儿童生长障碍中的应用和思考

周建华

doi:10.7499/j.issn.1008-8830.2410023

PDF(544 KB)

HTML

中国当代儿科杂志 ›› 2025, Vol. 27 ›› Issue (2) : 133-138. DOI: 10.7499/j.issn.1008-8830.2410023

系列述评——生长障碍疾病诊疗

重组人生长激素在治疗慢性肾脏病儿童生长障碍中的应用和思考

周建华

作者信息 +

Application and considerations of recombinant human growth hormone in treating growth disorders in children with chronic kidney disease

ZHOU Jian-Hua

Author information +

文章历史 +

摘要

生长障碍是儿童慢性肾脏病（chronic kidney disease, CKD）较为常见的并发症之一，对CKD儿童的生活质量和生存期均产生不良影响。重组人生长激素是治疗CKD儿童生长障碍的有效方法。该文对CKD儿童生长障碍的发生机制，重组人生长激素的治疗效果、安全性、注意事项，以及诊疗长期管理进行综述。

Abstract

Growth disorders are one of the common complications of chronic kidney disease (CKD) in children, adversely affecting both the quality of life and survival time of CKD patients. Recombinant human growth hormone (rhGH) is an effective treatment for growth disorders in children with CKD. This article reviews the mechanisms underlying growth disorders in children with CKD, the therapeutic effects, safety, and precautions of rhGH, and long-term management of diagnosis and treatment of this disorder.

导出引用

周建华. 重组人生长激素在治疗慢性肾脏病儿童生长障碍中的应用和思考[J]. 中国当代儿科杂志. 2025, 27(2): 133-138 https://doi.org/10.7499/j.issn.1008-8830.2410023

ZHOU Jian-Hua. Application and considerations of recombinant human growth hormone in treating growth disorders in children with chronic kidney disease[J]. Chinese Journal of Contemporary Pediatrics. 2025, 27(2): 133-138 https://doi.org/10.7499/j.issn.1008-8830.2410023

参考文献

1 魏雅琴, 李晓洁, 高春林, 等. 儿童慢性肾脏病生长发育障碍的病因及治疗[J]. 中华儿科杂志, 2023, 61(5): 474-477. PMID: 37096271. DOI: 10.3760/cma.j.cn112140-20221104-00936.
2 中华医学会儿科学分会肾脏学组, 中华儿科杂志编辑委员会. 中国儿童慢性肾脏病早期筛查临床实践指南（2021版）[J]. 中华儿科杂志, 2022, 60(9): 858-868. PMID: 36038293. DOI: 10.3760/cma.j.cn112140-20220714-00647.
3 中华医学会儿科学分会肾脏学组, 中华儿科杂志编辑委员会. 儿童慢性肾脏病生长障碍诊治循证指南[J]. 中华儿科杂志, 2022, 60(9): 869-876. PMID: 36038294. DOI: 10.3760/cma.j.cn112140-20220715-00648.
4 石鑫淼, 刘贝妮, 钟旭辉, 等. 儿童慢性肾脏病流行病学研究进展[J]. 中华儿科杂志, 2019, 57(9): 721-724. PMID: 31530363. DOI: 10.3760/cma.j.issn.0578-1310.2019.09.017.
5 Tabrizi M, Hoseini Nouri S A, Zarkesh M, et al. Management of growth in pediatric chronic renal failure: a narrative review[J]. J Pediatr Rev, 2022, 10(2): 121-128. DOI: 10.32598/jpr.10.2.584.4.
6 T?nshoff B, Niaudet P, Geffner ME, et al. Growth failure in children with chronic kidney disease: treatment with growth hormone[EB/OL]. (2023-04-12) [2024-10-10]. https://www.uptodate.com/contents/growth failure in children with chronic kidney disease treatment with growth hormone.
7 Santos F, Díaz-Anadón L, Ordó?ez FA, et al. Bone disease in CKD in children[J]. Calcif Tissue Int, 2021, 108(4): 423-438. PMID: 33452890. DOI: 10.1007/s00223-020-00787-z.
8 Drube J, Wan M, Bonthuis M, et al. Clinical practice recommendations for growth hormone treatment in children with chronic kidney disease[J]. Nat Rev Nephrol, 2019, 15(9): 577-589. PMID: 31197263. PMCID: PMC7136166. DOI: 10.1038/s41581-019-0161-4.
9 Kidney Disease : Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients[J]. Am J Transplant, 2009, 9 Suppl 3: S1-S155. PMID: 19845597. DOI: 10.1111/j.1600-6143.2009.02834.x.
10 Tang X, Chen Q, Chen J, et al. Growth hormone treatment in pre-pubertal short Chinese children with chronic kidney disease prior to transplantation[J]. Pediatr Res, 2023, 94(1): 268-274. PMID: 36539574. DOI: 10.1038/s41390-022-02429-6.
11 Haffner D, Schaefer F, Nissel R, et al. Effect of growth hormone treatment on the adult height of children with chronic renal failure. German Study Group for Growth Hormone Treatment in Chronic Renal Failure[J]. N Engl J Med, 2000, 343(13): 923-930. PMID: 11006368. DOI: 10.1056/NEJM200009283431304.
12 Wühl E, Haffner D, Nissel R, et al. Short dialyzed children respond less to growth hormone than patients prior to dialysis. German Study Group for Growth Hormone Treatment in Chronic Renal Failure[J]. Pediatr Nephrol, 1996, 10(3): 294-298. PMID: 8792393. DOI: 10.1007/BF00866763.
13 Jagodzinski C, Mueller S, Kluck R, et al. Growth hormone treatment in the pre-transplant period is associated with superior outcome after pediatric kidney transplantation[J]. Pediatr Nephrol, 2022, 37(4): 859-869. PMID: 34542703. PMCID: PMC8960657. DOI: 10.1007/s00467-021-05222-5.
14 王妍平, 王冠, 崔洪艳, 等. 胎儿生长受限对其肾脏发育的影响[J]. 国际妇产科学杂志, 2016, 43(1): 29-31.
15 Nagaeva EV. Short stature due to intrauterine growth retardation. Clinical and hormonal-metabolic features, possibilities of growth-stimulating therapy[J]. Probl Endokrinol (Mosk), 2022, 68(5): 4-13. PMID: 36337013. PMCID: PMC9762449. DOI: 10.14341/probl13178.
16 方香, 高春林, 夏正坤, 等. 儿童先天性肾发育异常的临床特征[J]. 发育医学电子杂志, 2022, 10(6): 447-452. DOI: 10.3969/j.issn.2095-5340.2022.06.008.
17 Vandenplas Y, Orsi M, Benninga M, et al. Infant gastroesophageal reflux disease management consensus[J]. Acta Paediatr, 2024, 113(3): 403-410. PMID: 38116947. DOI: 10.1111/apa.17074.
18 Rees L, Shaw V, Qizalbash L, et al. Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce[J]. Pediatr Nephrol, 2021, 36(1): 187-204. PMID: 32728841. PMCID: PMC7701061. DOI: 10.1007/s00467-020-04623-2.
19 付高宁, 张丽. 慢性肾脏病患者蛋白质能量消耗机制的研究进展[J]. 临床肾脏病杂志, 2021, 21(9): 776-779. DOI: 10.3969/j.issn.1671-2390.2021.09.014.
20 Afdhila IN, Amelin F, Akhyar G. The effectiveness of giving growth hormone to children with chronic kidney disease: systematic literature review[J]. Biomed J Indones, 2021, 7(3): 473-483.
21 Vimalachandra D, Craig JC, Cowell CT, et al. Growth hormone treatment in children with chronic renal failure: a meta-analysis of randomized controlled trials[J]. J Pediatr, 2001, 139(4): 560-567. PMID: 11598604. DOI: 10.1067/mpd.2001.117582.
22 Mehls O, Wühl E, T?nshoff B, et al. Growth hormone treatment in short children with chronic kidney disease[J]. Acta Paediatr, 2008, 97(9): 1159-1164. PMID: 18624988. DOI: 10.1111/j.1651-2227.2008.00845.x.
23 Hodson EM, Willis NS, Craig JC. Growth hormone for children with chronic kidney disease[J]. Cochrane Database Syst Rev, 2012, 2012(2): CD003264. PMID: 22336787. PMCID: PMC6599873. DOI: 10.1002/14651858.CD003264.pub3.
24 Sullivan KM, Kriegel AJ. Growth hormone in pediatric chronic kidney disease: more than just height[J]. Pediatric Nephrology, 2024, 39(11): 3167-3175. PMID: 38607423. DOI: 10.1007/s00467-024-06330-8.
25 Haffner D, Grund A, Leifheit-Nestler M. Renal effects of growth hormone in health and in kidney disease[J]. Pediatr Nephrol, 2021, 36(8): 2511-2530. PMID: 34143299. PMCID: PMC8260426. DOI: 10.1007/s00467-021-05097-6.
26 Mehls O, Lindberg A, Haffner D, et al. Long-term growth hormone treatment in short children with CKD does not accelerate decline of renal function: results from the KIGS registry and ESCAPE trial[J]. Pediatr Nephrol, 2015, 30(12): 2145-2151. PMID: 26198275. DOI: 10.1007/s00467-015-3157-8.
27 Yadin O. Over three decades of growth hormone treatment in children with chronic kidney disease-associated growth failure before and after kidney transplantation[J]. Pediatr Transplant, 2024, 28(5): e14803. PMID: 38899494. DOI: 10.1111/petr.14803.
28 Grenda R. Growth hormone therapy in pediatric kidney transplantation-the long-term clinical benefits beyond improvement of growth after withdrawal of pre-transplant therapy[J]. Pediatr Nephrol, 2022, 37(4): 699-702. PMID: 34542702. DOI: 10.1007/s00467-021-05223-4.
29 Boussetta A, Laamouri R, Jellouli M, et al. Efficacy of growth hormone treatment in children with chronic kidney disease: tunisian experience[J]. Indian Pediatr, 2021, 58(12): 1140-1142. PMID: 34939582.
30 Fine RN, Ho M, Tejani A, et al. Adverse events with rhGH treatment of patients with chronic renal insufficiency and end-stage renal disease[J]. J Pediatr, 2003, 142(5): 539-545. PMID: 12756387. DOI: 10.1067/mpd.2003.189.
31 《中国骨质疏松杂志》骨代谢专家组. 骨代谢生化指标临床应用专家共识（2023修订版）[J]. 中国骨质疏松杂志, 2023, 29(4): 469-476. DOI: 10.3969/j.issn.1006-7108.2023.04.001.
32 王诗涵, 王顺. 慢性肾脏病微炎症反应新型治疗靶点研究进展[J]. 临床肾脏病杂志, 2023, 23(9): 764-768. DOI: 10.3969/j.issn.1671-2390.2023.09.010.
33 冷洁, 程昕然. 正确认识生长激素在生长发育疾病中的应用[J]. 中华全科医师杂志, 2023, 22(7): 682-688. DOI: 10.3760/cma.j.cn114798-20230130-00084.
34 Cappa M, Maghnie M, Carbone V, et al. Summary of expert opinion on the management of children with chronic kidney disease and growth failure with human growth hormone[J]. Front Endocrinol (Lausanne), 2020, 11: 587. PMID: 33013690. PMCID: PMC7493742. DOI: 10.3389/fendo.2020.00587.
35 Allen DB, Julius JR, Breen TJ, et al. Treatment of glucocorticoid-induced growth suppression with growth hormone. National cooperative growth study[J]. J Clin Endocrinol Metab, 1998, 83(8): 2824-2829. PMID: 9709954. DOI: 10.1210/jcem.83.8.5036.
36 Oliveira EA, Carter CE, Mak RH. The role of growth hormone in chronic kidney disease[J]. Semin Nephrol, 2021, 41(2): 144-155. PMID: 34140093. DOI: 10.1016/j.semnephrol.2021.03.009.