本文選題：特發(fā)性矮身材 + 重組人生長激素　； 參考：《承德醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:本研究以青春期早期特發(fā)性矮身材兒童為研究對象,以骨鈣素、維生素D、胰島素樣生長因子-I等為研究指標,評價青春期骨生長情況,觀察重組人生長激素對骨代謝的影響,探討預(yù)測青春期ISS患兒療效的監(jiān)測指標;以身高、生長速率、骨齡等為評價指標,觀察重組人生長激素對青春期早期ISS患兒身高的促進作用,探討重組人生長激素治療對青春期早期ISS患兒終身高是否有益。方法:從2014年12月起至2016年12月期間,將就診于我院內(nèi)分泌科并確診為特發(fā)性矮身材的青春期早期患兒55例納入隨訪,同時給予飲食、運動、睡眠等合理指導(dǎo)并定期隨訪,隨訪時間12個月。根據(jù)治療與否分為治療組(26例)與未治療組(29例),并以青春期早期健康兒童作為對照組(25例)。嚴格執(zhí)行納入排出標準,收集入組兒童隨訪開始時的年齡、性別、身高、骨齡、胰島素樣生長因子-I、維生素D、骨鈣素、性激素等基本數(shù)據(jù)信息;收集ISS患兒父母的身高情況;收集隨訪第3月、6月、9月、12月的身高、體重測量數(shù)據(jù),IGF-I、骨鈣素的檢測數(shù)據(jù);第6月、12月的骨齡、維生素D的檢查檢測結(jié)果。計算身高標準差分值、遺傳靶身高及治療12月后的生長速率。采用SPSS19.0統(tǒng)計軟件進行數(shù)據(jù)分析,兩樣本比較采用t檢驗,多樣本比較采用方差分析,以P0.05為差異有統(tǒng)計學(xué)意義,比較三組兒童性激素水平、骨代謝指標、生長速率、骨齡的變化。結(jié)果:(1)三組兒童隨訪開始時睪酮/雌激素、促卵泡生成素、促黃體生成素水平比較差異均無統(tǒng)計學(xué)意義(男F=0.50,0.39,0.03;女F=0.48,0.14,0.99,P0.05)。治療組/未治療組ISS患兒維生素D水平與對照組比較差異均無統(tǒng)計學(xué)意義,P0.05(男22.68±12.81/20.52±11.60 VS 23.62±11.90F=0.41;女21.05±12.71/21.20±11.74 VS 22.35±12.26 F=0.05),但治療組/未治療組ISS患兒OC及IGF-I水平較對照組均顯著降低,比較差異均有統(tǒng)計學(xué)意義,P0.05(OC水平:男89.11±23.70/97.83±22.57 VS134.88±34.59,F=9.41;女91.20±24.56/98.67±25.38 VS 136.58±38.22,F=9.18)(IGF-I水平:男43.05±46.88/147.69±53.24 VS 195.50±58.16,F=3.51;女155.50±58.53/156.97±52.33 VS 211.34±61.38,F=4.28)。(2)治療1個月時,rh GH治療可使IGF-I明顯升高,與未治療組比較差異具有統(tǒng)計學(xué)意義(P0.05)。治療1月后IGF-I明顯升高,之后稍有下降,治療6月時,治療組IGF-I(男228.88±52.84 VS 180.73±50.85;女223.40±50.76 VS 178.40±54.91)、骨鈣素水平(男153.44±38.43 VS120.04±31.77;女154.15±35.30 VS 119.67±32.93)與未治療組比較明顯升高,差異有統(tǒng)計學(xué)意義,P0.05。治療1年后,骨齡有所變化,兩組骨齡差值(△BA)比較,差異無統(tǒng)計學(xué)意義;(3)隨訪1年中,所有入組兒童IGF-I呈持續(xù)增高趨勢,rh GH治療組較未治療組偏高。骨鈣素水平亦明顯升高。(4)兩組ISS患兒生長速率均逐漸增加,至隨訪結(jié)束,兩組ISS患兒Ht SDS比較差異無統(tǒng)計學(xué)意義,P0.05,但未治療組患兒身高平均增加(0.18±0.14)SD,治療組患兒身高平均增加(0.38±0.09)SD,相比治療前,兩組△Ht SDS差異具有統(tǒng)計學(xué)意義,P0.05。(5)隨訪治療的16例ISS患兒中,經(jīng)rh GH治療后均無血、尿常規(guī)、肝腎功能、血糖、腹部臟器彩超檢查的異常。發(fā)生膝關(guān)節(jié)疼痛1例,亞臨床甲減1例,無過敏、視力下降、頭痛等副作用發(fā)生。結(jié)論:(1)與健康兒童相比,青春期早期ISS患兒成骨細胞呈低代謝狀態(tài),生長速率偏低,骨生長落后;(2)重組人生長激素可促進青春期早期ISS患兒體內(nèi)IGF-I、OC的生成增加,骨合成指標升高,加快骨形成,促進骨生長;(3)骨鈣素水平能較好的反應(yīng)生長速率,是rh GH治療青春期ISS患兒療效的良好監(jiān)測指標;(4)重組人生長激素治療青春期早期特發(fā)性矮身材兒童,可促進生長速率增加,短期內(nèi)對骨齡無影響;可使終身高增加,但獲益有限。
[Abstract]:Objective: in this study, early adolescent idiopathic short stature children were studied with osteocalcin, vitamin D, and insulin-like growth factor -I as research indicators to evaluate the growth of bone in puberty, observe the effect of recombinant human growth hormone on bone metabolism, and explore the monitoring indexes for predicting the curative effect of children with ISS in puberty, and the height and growth rate, The effect of recombinant human growth hormone (GH) on the height of ISS children in early puberty was observed and the effect of recombinant human growth hormone therapy on the final height of early puberty in children with ISS was investigated. 55 cases of early stage children were followed up, while diet, exercise, sleep and other reasonable guidance were given and followed up for 12 months. According to the treatment or not, the treatment group (26 cases) and the untreated group (29 cases), and the early puberty healthy children as the control group (25 cases), were strictly enforced into the discharge standard and collected into the group of children to follow up the follow up. The basic data of age, sex, height, bone age, insulin-like growth factor -I, vitamin D, osteocalcin, sex hormone, and other basic data were collected; the height of the parents of children with ISS was collected; the height, weight measurement data, IGF-I, and osteocalcin were collected for third months, June, September, December, and the results of sixth months, December bone age, and vitamin D examination results The standard difference of height, height of genetic target and the growth rate after December were calculated. The data were analyzed by SPSS19.0 software. The two samples were compared with t test. The variances were analyzed by variance analysis, and the difference of P0.05 was statistically significant. The changes of the level of sex, bone metabolism, growth rate and bone age of the three groups were compared. Results: (1) there was no significant difference in testosterone / estrogens, follicle stimulating hormone and luteinizing hormone levels in the three groups of children (male F=0.50,0.39,0.03, F=0.48,0.14,0.99, P0.05). There was no significant difference in vitamin D between the treatment group / untreated group of ISS and the control group, P0.05 (male 22.68 + 12.81/20.52). 11.60 VS 23.62 + 11.90F=0.41, female 21.05 + 12.71/21.20 + 11.74 VS 22.35 + 12.26 F=0.05, but the level of OC and IGF-I in ISS children in the treatment group / untreated group were significantly lower than those in the control group, and the difference was statistically significant. P0.05 (OC level: male 89.11 + 23.70/97.83 + 22.57 VS134.88 34.59, 91.20 + 91.20 + 25.38 + 136.5) 8 + 38.22, F=9.18) (IGF-I level: male 43.05 + 46.88/147.69 + 53.24 VS 195.50 + 58.16, F=3.51; female 155.50 + 58.53/156.97 + 52.33 VS 211.34 + 61.38, F=4.28). RH GH treatment can make IGF-I increase, and there is a significant difference with the untreated group (P0.05). After January, the treatment significantly rises, then a slight decline. In June, the treatment group IGF-I (228.88 + 52.84 VS 180.73 + 50.85; female 223.40 + 50.76 VS 178.40 + 54.91), osteocalcin level (male 153.44 + 38.43 VS120.04 + 31.77, and 154.15 + 35.30 VS 119.67 + +) were significantly higher than those in the untreated group, and the difference was statistically significant. The bone age difference was changed after P0.05. treatment. There was no statistically significant difference in Delta BA. (3) in the 1 year follow-up, all the children in the group had a continuous increase in IGF-I, and the RH GH treatment group was higher than the untreated group. (4) the growth rate of the two groups of ISS children increased gradually, to the end of the follow-up, there was no statistical difference between the two groups of ISS children with Ht SDS, P0.05, but not treated. The average height of the children in the group increased (0.18 + 0.14) SD, and the average height of the children in the treatment group increased (0.38 + 0.09) SD. Compared with the two groups before the treatment, the difference in the delta Ht SDS was statistically significant. In 16 cases of ISS children with P0.05. (5) follow-up treatment, there were no blood, urine routine, liver and kidney function, blood glucose, abdominal organ color Doppler ultrasonography after RH GH. 1 cases of pain and 1 subclinical hypothyroidism, no anaphylaxis, loss of vision, headache and other side effects. Conclusion: (1) compared with healthy children, the osteoblasts of early puberty ISS children showed low metabolic state, low growth rate, and backward bone growth. (2) recombinant human growth hormone could promote the formation of IGF-I, OC and bone synthesis in the early puberty of children. The index increases, accelerate bone formation, promote bone growth; (3) osteocalcin level can better respond to growth rate, is a good monitoring index of the effect of RH GH in the treatment of puberty ISS children; (4) recombinant human growth hormone treatment of early adolescent idiopathic short stature children, can promote growth rate, no effect on bone age in the short term; can make life-long increase Add, but the benefit is limited.
【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.8

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