Effects And Influencing Factors Of Therapy With Recombinant Human Growth Hormone (RhGH)on Linear Growth In Children With Short Stature

Object:1.To explore the therapeutic effects of replacement therapy with domestic recombinant human growth hormone (rhGH) on the liner growth of children with growth horomone deficiency (GHD) and idiopathic short stature (ISS).2. To observe the changes of Insulin-Like Growth Factor1(IGF-1), Insulin-Like Growth Factor Binding Protein3, the thyroid hormone (TH) and the fasting blood glucose (FBG) during the treatment of rhGH.3. To analysis the influencing factors of therapy with recombinant Human Growth Hormone on Linear Growth in Children with Short Stature.Materials and Methods:29GHD children and16ISS children were treated with rhGH in the clinic of Tianjin Medical University General Hospital. The doses of rhGH for GHD and ISS are0.10IU/(kg.d) and0.15IU/(kg.d).rhGH was administered by subcutaneous injection in bed time everyday.Some patients of short stature was collected the serum before and after treatment for every3months of follow-up (16GHD cases and12ISS cases).All of the patients were followed up in clinic after treatment respectively every three months.The detailed medical history, complete physical examination and the necessary laboratory tests were taken for the patients during the follow-up.Height, Weight, FBG, free three iodinearmour gland original acid, free thyroxine hyroid-stimulating hormone, bone age。Growth hormone proocation tests。Head nuclear magnetic resonance (NMR。Body Mass Index (BMI) and Height Standard Deviation Score (HtSDS), Growth Velocity (GV), Mid-Parental Heigh (MPH), the behindhand degree of Bone Age (BA-CA) and the index of bone age maturity (BA/CA) were computed. Insulin-like Growth Factor-1(IGF-1) and Insulin-Like Growth Factor Binding Protein3(IGFBP-3) were determined by the method of chemiluminescent immunoassay.The data was analysed by SPSS17.0(t test, Pearson correlation analysis and χ2test).P<0.05with a statistical significance.Results:1.After3and6months of rhGH therapy, Ht, HtSDS, GV of increased(P<0.05orP<0.001) in all the patients.The BMI slightly increase, but the difference was not statistically significant(P>0.05).The BA/CA difference was not statistically significant (P>0.05), too.2.The△Ht, GV was higher during0-3month treatment than those during 3-6month treatment, but the difference was not statistically significant (P>0.05)3.In the same period of treatment the GV of GHD group was higher than that of ISS group and the differences had statistical significance (P<0.05or P<0.001)4.IGF-1and IGFBP-3of GHD or ISS groups was increased after the treatment.5.FBG and FT3were increased and FT4was decreased after the therapy both in GHD and ISS group. The difference had statistical significance (P<0.05).The changes of TSH had no statistical significance (P>0.05).6.In patient with GHD, GV3was related with GH stimulating peak (r=-0.42, P=0.02); GV6was related with FT3(r=0.38, P=0.04), HtSDS (r=-0.56, P=0.002), GV3(r=0.52, P=0.004), GH stimulating peak(r=-0.38,P=0.04). In patient with ISS, GV3was related with Ht(r=-0.55, P=0.03), HtSDS(r=-0.51, P=0.04), BA(r=-0.55, P=0.03), IGFBP-3(r=-0.79, P=0.003). GV6was related with GV3(r=0.65, P=0.01), BA (r=-0.55, P=0.03), BA-CA (r=-0.54, P=0.03), HtSDS (r=-0.64, P=0.01).7.FT3both before and after3month treatment had a positive correlation with IGF-1in patient with GHD.FT3before treatment had a positive correlation with IGF-1in patient with ISS.Conclusions:1. The replacement therapy of the rhGH can effectively improve the height of children with GHD and ISS and won’t accelerate BA mature.The effect of rhGH treatment on GHD children is better.2. FBG,FT3,FT4,IGF-1,IGFBP-3in children with GHD and ISS had significant changes after the treatment. These index were key indicators for monitoring the curative effect and side effects of rhGH therapy. We should actively monitor them during treatment.3. In patient with GHD,the GH stimulating peak was related with GV3;HtSDS before treatment,FT3before treatment and GV3,the GH stimulating peak was related with GV6.In patient with ISS,Ht,HtSDS before treatment,BA before treatment,IGFBP-3was related with GV3;GV3,BA before treatment,BA-CA,HtSDS before treatment was related with GV6.