| Objective:In this study,observing early pubertal children with idiopathic short stature as the research object,taking the osteocalcin,vitamin D,insulin-like growth factor-I as the research index,the study evaluated the growth of adolescent bone,observed the effect of recombinant human growth hormone on bone metabolism and looked for indicators to predict the efficacy of recombinant human growth hormone on pubertal ISS patients.The study evaluated the effect of recombinant human growth hormone on height of early puberty children with ISS by height,growth velocity and bone age and investigated the recombinant human growth hormone therapy whether was beneficial to early puberty children with ISS.Methods:During December 2014 to December 2016,the study included in the patients(55)who diagnosed with idiopathic short stature in early puberty,from the department of endocrinology in the Hospital,while giving the diet,exercise,sleep and other reasonable guidance and be regularly followed-up,the follow-up time was 12 months.According to be treated or not treated,the patients were divided into treatment group(n=26)and the untreated group(n=29);the early healthy children as control group(n=25).The study strictly executeed the Inclusion and emission standards.The data of age,sex,height,skeletal age,insulin like growth factor-I,vitamin D,osteocalcin,sex hormones and other basic data were collected monthly in the follow-up time;the height of parents of children with ISS were collected;the data of serum IGF-I level,the serum osteocalcin level,bone age and the serum vitamin D level were collected.Calculate the height standard deviation score,target height and treatment after the December growth rate.SPSS19.0 statistical software was used for data analysis,Two samples were compared using t test,and the variance analysis was used for comparison,the difference was statistically significant with P<0.05.The changes of sex hormone,bone metabolism,growth rate and bone age were compared between the three groupsResult:(1)There was no significant difference in the levels of testosterone,estradiol,follicle stimulating hormone and luteinizing hormone in the three groups(boy F=0.50,0.39,0.03;girl F=0.48,0.14,0.99,P>0.05).There was no significant difference in the levels of vitamin D in the ISS groups and the control group(boy 22.68±12.81/20.52±11.60 VS 23.62±11.90 F=0.41;girl 21.05±12.71/ 21.20±11.74 VS 22.35±12.26 F=0.05),But the treatment group / untreated group with ISS children's OC levels were significantly lower than the control group(boy 89.11±23.70/97.83±22.57 VS 134.88±34.59 F=9.41;girl 91.20±24.56/98.67±25.38 VS 136.58±38.22 F=9.18)and IGF-I(boy 43.05±46.88/147.69±53.24 VS 195.50±58.16 F=3.51;girl 155.50±58.53/156.97±52.33 VS 211.34±61.38 F=4.28),the differences were statistically significant,P < 0.05.(2)After 1 months of treatment,rh GH treatment can significantly increase the IGF-I,compared with the untreated group,the difference was statistically significant(P<0.05).After 1 months of treatment,IGF-I reached the peak,then decreased slightly,after 6 months of treatment,the treatment group IGF-I compared with the untreated group was significantly increased,the difference was statistically significant(boy 228.88±52.84 VS 180.73±50.85;girl 223.40±50.76 VS 178.40±54.91),osteocalcin(boy 153.44±38.43 VS 120.04±31.77;girl 154.15±35.30 VS 119.67±32.93),P<0.05.After 1 years of treatment,bone age changed,the difference of two groups bone age(?BA),was not statistically significant.(3)During the follow-up of 1 years,the serum IGF-I levels in all the children showed a trend of increasing,while the serum IGF-I level in the rh GH group was higher than that in the untreated group.The level of serum osteocalcin was significantly increased.(4)The growth velocity of the two groups of children with ISS gradually increased,to the end of follow-up,the two groups had no statistically significant difference in Ht SDS,P>0.05.but in the untreated group,the average height increased(0.18±0.14)SD,in the treatment group,the average height increased(0.38±0.09)SD,compared in ?Ht SDS,the two groups had statistically significant difference,P < 0.05.(5)16 cases of ISS patients in the follow-up time,after rh GH treatment,showed no abnormal in blood and urine routine,liver and kidney function,blood glucose and abdominal ultrasonography.1 cases had knee joint pain,1 case had subclinical hypothyroidism.There were no allergy,decreased visual acuity,headache and other side effects.Conclusion:(1)Compared with the healthy children,the osteoblasts of ISS children in early puberty showed low metabolism,the growth velocity was lower,and the growth of bone was backward;(2)The recombinant human growth hormone can promote the produce of IGF-I and OC in the early puberty children with ISS and increase the index of bone synthesis,accelerate bone formation and promote bone growth;(3)The serum osteocalcin level can reflect the growth velocity of ISS patients who treated by rh GH.It is good curative index in the treatment by rh GH for adolescent ISS;(4)The recombinant human growth hormone therapy in early puberty children with idiopathic short stature,can promote the growth velocity,the short term has no effect on bone age,the final height can be increased,but benefit limited. |
PDF Full Text Request