最新研究發(fā)現(xiàn),，即使延遲至青春期給予生長激素(GH)治療,，仍可改善出生時小于胎齡的矮小兒童的成年身高。結果于8月17日在線發(fā)表于《臨床內分泌和代謝雜志》(Journal of Clinical Endocrinology & Metabolism),。
來自荷蘭Cutch生長研究基金會的Lem醫(yī)師是本次研究的主要人員,，他表示，我們的結果不會導致生長激素治療延遲至青春期,，因為兒童期和青春期身高正常有重要優(yōu)勢。然而,，在臨床實踐中,，當兒童在青春期出現(xiàn)身材矮小癥時，也不能將他們排除在生長激素治療之外,。
約10%的出生時小于胎齡的兒童有持續(xù)性身材矮小癥,，生長激素可改善他們的生長和成年身高。但是據(jù)假設,，作為骨骺成熟的方法,，青春期生長激素治療的效果有限。
Lem醫(yī)師和同事在本次隨機試驗中納入了121名這類兒童(年齡均≥8歲),，以比較標準生長激素劑量(1 mg/m2/天)和雙倍生長激素劑量(2 mg/m2/天),。40名青春期開始時身高不足140 cm的兒童也接受了一種促性腺激素釋放激素(GnRH)類似物治療。
雙倍劑量生長激素組女孩和男孩的成年身高均顯著高于標準劑量生長激素組,。青春期前開始生長激素治療的兒童與青春期開始生長激素治療的兒童的成年身高相似,。
在84名于研究期達到成年身高的兒童中，中位身高從-2.9標準差評分(SDS)增至-1.7,。
62%的兒童達到-2 標準差評分(SDS)以上的成年身高,，70%達到目標身高范圍的成年身高。身高增長范圍從-0.7 至+3.3 標準差評分(SDS)。
生長激素聯(lián)合或不聯(lián)合其他GnRH類似物治療可導致相似的成年身高標準差評分(SDS),，研究者指出,，這表明，由于未達到成年身高預期而在青春期開始時接受其他GnRHa治療的兒童獲得的成年身高標準差評分(SDS)與不接受其他GnRHa治療的兒童相當,。”
接受雙倍劑量生長激素治療的青春期兒童的IGF-I顯著高于接受標準劑量生長激素治療的兒童,。生長激素治療總體上耐受良好，并且沒有不良事件被歸因于生長激素治療,。
Lem醫(yī)師認為,，在臨床實踐中，最好以標準劑量的生長激素(1 mg/m2/天)開始進行治療,，因為在此項研究中,，青少年顯示出用該劑量也可獲得顯著的身高增長。當兒童顯示出追趕生長不足,、青春期/骨齡快速進展或其他GnRH-a(人工合成的GnRH)治療抑制性激素時,，醫(yī)師應考慮增加生長激素的劑量。
需要隨訪至成年期以研究生長激素治療的極長期效果和以后成年期高IGF-I水平的可能效應,。因此,，Lem醫(yī)師希望盡可能多地收集在此項研究中接受治療的兒童的詳細長期隨訪數(shù)據(jù)。”（生物谷Bioon.com）
doi:10.1210/jc.2012-1987
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PMID:
Adult Height in Short Children Born SGA Treated with Growth Hormone and Gonadotropin Releasing Hormone Analog: Results of a Randomized, Dose-Response GH Trial.
Lem AJ, van der Kaay DC, de Ridder MA, Bakker-van Waarde WM, van der Hulst FJ, Mulder JC, Noordam C, Odink RJ, Oostdijk W, Schroor EJ, Sulkers EJ, Westerlaken C, Hokken-Koelega AC.
Context:GH treatment is effective in improving height in short children born small for gestational age (SGA). GH is thought to have limited effect when started during adolescence.Objective:The aim of this study was to investigate GH treatment efficacy in short SGA children when treatment was started during adolescence; to assess whether GH 2 mg/m(2) · d during puberty improves adult height (AH) compared with 1 mg/m(2) · d; and to assess whether an additional 2-yr postponement of puberty by GnRH analog (GnRHa) improves AH in children who are short at the start of puberty (<140 cm), with a poor AH expectation.Patients and Design:In this longitudinal, randomized, dose-response GH trial, we included 121 short SGA children (60 boys) at least 8 yr of age. We performed intention-to-treat analyses on all children and uncensored case analyses on 84 children who reached AH. Besides, we evaluated growth during 2 yr of combined GH/GnRHa and subsequent GH treatment until AH in a subgroup of 40 pubertal children with a height of less than 140 cm at the start.Results:Short SGA children started treatment at a median age of 11.2 yr, when 46% had already started puberty. Median height increased from -2.9 at start to -1.7 sd score (SDS) at AH (P < 0.001). Treatment with GH 2 vs. 1 mg/m(2) · d during puberty resulted in significantly better AH (P = 0.001), also after correction for gender, age at start, height SDS at start, treatment years before puberty, and target height SDS. AH was similar in children who started puberty at less than 140 cm and received GH/GnRHa, compared with children who started puberty greater than 140 cm and received GH only (P = 0.795).Conclusion:When started in adolescence, GH treatment significantly improves AH in short SGA children, particularly with GH 2 mg/m(2) · d during puberty. When SGA children are short at the start of puberty, they can benefit from combined GH/GnRHa treatment.
