發(fā)布時(shí)間：2018-02-01 00:29

  本文關(guān)鍵詞： 生長激素缺乏癥 特發(fā)性矮小 重組人生長激素治療 胰島素樣生長因子-1 胰島素樣結(jié)合蛋白-3　出處：《天津醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：1.比較國產(chǎn)重組人生長激素(recombinant human growth hormone, rhGH)對生長激素缺乏癥(growth horomone deficiency, GHD)患兒和特發(fā)性矮小癥(idiopathic short stature, ISS)患兒促身高線性生長的治療效果。 2.觀察rhGH治療過程中血清胰島素樣生長因子-1(insulin-like growth factor1, IGF-1),胰島素樣結(jié)合蛋白-3(insulin-like growth factor binding protein3, IGFBP-3),甲狀腺激素(thyroid hormone, TH)以及空腹血糖(fasting blood glucose, FBG)的變化。 3.分析臨床上可能影響rhGH促身高線性生長治療效果的因素。方法：選擇就診于天津醫(yī)科大學(xué)總醫(yī)院兒童內(nèi)分泌門診并經(jīng)過rhGH治療的矮小癥患兒45例(GHD患者29例,ISS患者16例),治療劑量為GHD0.10IU/(kg.d), ISS0.15IU/(kg.d),每晚睡前皮下注射。收集其中30例矮小病人的治療前及治療后每隔3個(gè)月隨診時(shí)的血清(其中GHD患者16例,ISS患者12例)。病例均于治療后每隔3個(gè)月進(jìn)行隨診,收集病例的臨床資料,詳細(xì)采集病史,進(jìn)行全面的體格檢查,測量患兒身高(height, Ht),體重(weight, Wt),檢測FBG,游離三碘甲腺原氨酸(free three iodine armour gland original acid, FT3),游離甲狀腺素(free thyroxine, FT4),促甲狀腺素(thyroid-stimulating hormone, TSH)等生化指標(biāo),檢測骨齡(bone age, BA),進(jìn)行生長激素激發(fā)試驗(yàn),頭顱核磁共振等檢查。計(jì)算體質(zhì)指數(shù)(body mass index, BMI)、身高標(biāo)準(zhǔn)差積分(height standard deviation of points, HtSDS),生長速率(growth velocity, GV),父母遺傳中位身高(mid-parental height, MPH),骨齡落后程度(BA-CA),骨齡成熟度(BA/CA)等指標(biāo)。用化學(xué)發(fā)光法檢測血清IGF-1, IGFBP-3.采用SPSS17.0統(tǒng)計(jì)軟件,比較GHD (ISS)(?)臺(tái)療前、后的生長參數(shù)(Ht,HtSDS,GV,BA/CA,BMI)變化以及血清生化指標(biāo)(IGF-1, IGFBP-3, FT3, FT4, TSH, FBG)變化；比較治療0-3個(gè)月與治療3-6個(gè)月的生長參數(shù)(△Ht,GV);比較兩組(GHD與ISS)的治療3個(gè)月的生長速率(GV3),治療6個(gè)月的生長速率(GV6)；采用Pearson相關(guān)分析方法,分析GV3、GV6與實(shí)際年齡(chronological age, CA),開始治療時(shí)的Ht, HtSDS, BA, BA-CA,生長激素激發(fā)試驗(yàn)峰值(GH峰值),MPH,IGF-1, IGFBP-3, FT3, GH劑量等臨床指標(biāo)的相關(guān)關(guān)系。P0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果：1.GHD和ISS患兒治療3、6個(gè)月的Ht,HtSDS, GV均較治療前升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05或P0.001),治療3、6個(gè)月的BMI稍有增加,但差異無統(tǒng)計(jì)學(xué)意義(P0.05),治療3、6個(gè)月的BA/CA差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 2.GHD和ISS患兒治療0-3個(gè)月的△Ht,GV高于治療3-6個(gè)月,但差異無統(tǒng)計(jì)學(xué)意義(PO.05)。 3.GHD組GV3,GV6均高于ISS組,差異有統(tǒng)計(jì)學(xué)意義(P0.05或P0.001)。 4.GHD與ISS組治療前與治療3、6個(gè)月的IGF-1,IGFBP-3水平成遞增趨勢,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 5.GHD, ISS兩組治療后的FT3均較治療前升高,FT4較治療前下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05), TSH的變化無統(tǒng)計(jì)學(xué)意義(P0.05),FBG較治療前升高差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 6.GHD組GV3與GH峰值(r=-0.42,P=0.02)成負(fù)相關(guān)；GV6與治療前FT3(r=0.38,P=0.04), GV3(r=0.52,P=0.004)成正相關(guān),與治療前HtSDS (r=-0.55, P=0.002),GH峰值(r=-0.38,P=0.04)成負(fù)相關(guān)。ISS組GV3與治療前Ht(r=-0.55, P=0.03),治療前HtSDS(r=-0.51,P=0.04),治療前BA(r=-0.55,P=0.03), IGFBP-3(r=-0.79, P=0.003)成負(fù)相關(guān)；GV6與GV3(r=0.64,P=0.01)成正相關(guān),與治療前BA (r=-0.55, P=0.03), BA-CA (r=-0.54, P=0.03)治療前HtSDS (r=-0.64, P=0.01)成負(fù)相關(guān)。 7.GHD組IGF-1與治療前FT3(r=0.57,P=0.02)、治療3個(gè)月的FT3(r=0.57,P=0.02)成正相關(guān)；ISS組IGF-1與治療前的FT3(r=0.63,P=0.03)成正相關(guān)。 結(jié)論：1.國產(chǎn)rhGH短期治療可以有效改善GHD及ISS患兒身高,而且前3個(gè)月的治療效果較好。與ISS相比,rhGH治療對GHD患兒身高增長更明顯。國產(chǎn)rhGH短期治療不會(huì)加速BA成熟。 2.治療過程中GHD, ISS患兒的FBG,FT3,FT4,IGF-1,IGFBP-3都有顯著變化,是監(jiān)測療效和觀察副作用的關(guān)鍵指標(biāo),應(yīng)該在治療期間積極動(dòng)態(tài)監(jiān)測。 3.與GHD患兒的GV3相關(guān)因素為：GH峰值；與GV6相關(guān)的因素為：治療前FT3,治療前HtSDS, GV3,峰值。與ISS患兒的GV3相關(guān)因素為：治療前Ht,治療前HtSDS,治療前BA,治療前IGFBP-3;與GV6相關(guān)的因素為：GV3,治療前BA, BA-CA,治療前HtSDS.
[Abstract]:Objective : To compare the therapeutic effects of recombinant human growth hormone ( rhGH ) on growth hormone deficiency ( GHD ) and idiopathic short stature ( ISS ) in children with growth hormone deficiency ( ISS ) . 2 . The changes of serum insulin - like growth factor 1 ( IGF - 1 ) , insulin - like growth factor binding protein 3 ( IGF - 1 ) , thyroid hormone ( TH ) and fasting blood glucose ( FBG ) were observed during rhGH treatment . Methods : Forty - five patients ( 29 patients with GHD and 16 ISS ) treated with rhGH were selected from 45 patients ( 29 patients with GHD patients and 16 ISS patients ) who were treated with rhGH . The therapeutic doses were GHD0.10 IU / ( kg 路 d ) and ISS0.15IU / ( kg 路 d ) . Serum of 30 cases of short patients before and after treatment ( 16 patients with GHD patients and 12 ISS patients ) were collected . The indexes such as body mass index ( BMI ) , height standard deviation of points ( FT3 ) , free thyroxin ( FT4 ) and thyroid - stimulating hormone ( TSH ) were measured . The growth parameters ( Ht , HtSDS , GV , BA / CA , BMI ) and serum biochemical indexes ( IGF - 1 , IGFBP3 , FT3 , FT4 , TSH , FBG ) were compared between 0 - 3 months and 3 - 6 months ( GV3 ) . Results : 1 . The Ht , HtSDS and GV were higher in the patients with GHD and ISS than before treatment ( P0.05 or P0.001 ) , but there was no significant difference in BMI between 3 and 6 months ( P0.05 ) . There was no significant difference in BA / CA in 3 and 6 months ( P0.05 ) . 2.GHD and ISS children treated for 0 - 3 months 鈻，

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