The Value Of The Insulin With Arginine Provocation Test And The Therapeutic Effect Of Recombinant Human Growth Hormone On Children With Growth Hormone Deficiency

Objective:Growth hormone deficiency(GHD),witch will lead to adult short stature,is one of the most important reason to affect the quality of life,clearly diagnosis is essential befor treatment.This study lead to evaluate the value of the insulin and arginine provocation test on 65 children with short stature.And also to anaylize the therapeutic effect and the safety of China- made recombinant human growth hormone(r-hGH) through 35 case.Methods:(1)65 short stature children were performed the drug probocation test:①Insulin was intravenous injected with 0.075-0.1U/Kg,detected the glucose levers at 0,15,30,60,90minuts after injection,and their levers of growth hormone(GH) were also detected at 0,30,60,90,120 minuts,kept observing the reactions during the whole test.②The arginine provocation test was performed at least 2 days later:10% arginine was intravenous infused in 30 minuts,detected the GH levers at 0,30,60,90,120 minuts.Compared the accuracy of different tests.(2)35 children with GHD were included in this study,they were treated with China-made r-hGH replacement therapy,with dosage of 0.1 IU/Kg·d, injected subcutaneously before sleeping every night,27 children were treated for 12 months.The body height,body weight were separately examined every month,T3,T4,TSH and glucose were examined every 3 months,the bone age was examined every 6 months,the results were compared before and after the therapy,evaluate the therapeutic effect and the safety of r-hGH. Results:(1)①The accuracy of the test was:the insulin provocation test 80%,the arginine provocation test 66.7%,the two tests 96.6%(P<0.05).②In the insulin provocation test,low glucose occurred during the 15-30 minuts after injection,8 children had minor low glucose symptoms, the Minimum lever of glucose had positive correlation with the body weight and BMI; No adverse reactions were found in the arginine provocation test.③Peak values of GH appeared in different times: the arginine provocation test was 60-120 minuts after injection and the insulin was 30-90 minuts.(2)①The growths of GHD children after 12 months therapy were obviously increased in body height,height velocity and height SDS.The average of height velocity,witch was less than 4cm/year before treatment, was increased into 12.5±2.4cm/year after therapy,the number had significant differences before and after therapy.②The separately height velocity after 3,6 and 12 months treatment was:13.8±2.4cm/year, 14.7±2.4 cm/year,12.5±2.4 cm/yeat.③During the thetapy period,5 children were found lower lever of T4,no change with T3 and TSH,no hypothyroidism symptom, the lever of T4 returned to normal after acceding to thyroxine tablets;3 children had mild swelling in the injection site at the beginning;2 children had transitory hyperglycemia;1 case had some Intracranial hyper- tension symptoms just like headache,vomit,accompanied with edema after 2-3 weeks treatment,those symptoms disappeared after finishing therapy,no serious adverse reactions were found.Conclusion:(1)The accuracy of the insulin provocation test is better than the arginine provocation test;Two drug provocation test is more accurate than single drug provocation test;(2)The r-hGH replacement therapy for GHD children is effective,the body height and height velocity are obviously increased,it can improve the height SDS, witch is significant effect to improve the adult height.