Serum Uric Acid Levels In Children With Prepubertal Idiopathic Short Stature Before And After Treatment With Recombinant Human Growth Hormone

BackgroundThe pathogenesis of short stature（SS）is more complicated,and factors such as congenital heredity,living environment and physical exercise are all related to its pathogenesis.The clinical symptoms of children with SS are that even if they live in a similar environment,their height is significantly lower than the average height of people of the same age,sex,and race with normal development.According to statistics,the average height of children with SS is 2 standard deviations or the 3rd percentile of the average height of normal children.The incidence rate is about 2-3%,among which 60%to 80%of children with short stature are idiopathic short stature（ISS）^[1-3].Its pathogenesis is not clear^[4].Growth hormone-insulin like growth factor-1（GH-IGF-1）axis plays an extremely important role in regulating the growth and development of children^[5].The growth and development of children and adolescents are closely related to the levels of insulin like growth factor-1（IGF-1）or growth hormone（GH）in their bodies.When any one of the biological factors is low in children and adolescents in the growth and development period,they can cause short stature^[6].At present,the most effective drug for the treatment of short stature is recombinant human growth hormone（rh GH）.Studies have confirmed that in children with ISS who received rh GH treatment,the growth rate（growth velosity,GV） increased significantly,and the height（height,Ht）level and height standard deviation score（Ht SDS）have been effectively improved,and the level of IGF-1 in the patient’s body has been significantly increased^[7].GH can not only promote linear growth,but may also affect the body’s metabolism,including thyroid function,blood sugar,liver and kidney function and other indicators.Uric acid（UA）is a metabolite.When the uric acid level exceeds a reasonable range,it will have many adverse effects on the human body.For children and adolescents,it will bring extremely negative effects on growth and development^[8-9].Hyperuricemia in children in the growth and development period will further affect their physiological health indicators^[10-11].Recent studies have found that many metabolic diseases are closely related to uric acid levels.In children with ISS,the concentration of IGF-1 that promotes the growth and development of children and adolescents has a certain correlation with the level of uric acid in their bodies^[12].Relevant studies have shown that the body mass index（BMI）value of short and short people has an important influence on their uric acid level^[13].Therefore,the blood uric acid level is closely related to the growth and development of children.At present,there is no correlation study on the changes of serum uric acid levels before and after rh GH treatment in children with ISS.Therefore,this study observed the changes in blood uric acid levels before and after rh GH treatment in prepubertal ISS children,and analyzed its correlation with other growth indicators through relevant mathematical statistical analysis methods,and explored the effects of rh GH treatment on blood uric acid in prepubertal ISS children for 12 months.The influence of the level and its relationship with other growth indicators provide theoretical basis and reasonable and effective medical advice for the later clinical diagnosis and treatment of children with ISS.ObjectiveObserve and count the changes in blood uric acid levels before and after rh GH treatment in children with prepubertal ISS,explore the effect of rh GH treatment on blood uric acid levels in children with prepubertal ISS for 12 months and its correlation with other growth indicators.Accordingly,the scientific and theoretical basis for clinical diagnosis and treatment of children with ISS is provided.MethodsThe children who were treated and examined in the Pediatric Endocrinology Clinic of the Third Affiliated Hospital of Zhengzhou University from September 2017to September 2019 were included in the statistical standards.Among them,the ISS group consisted of 153 prepubertal ISS children who had undergone rh GH standard intervention for 1 year.There were 153 cases of the same age and sex as the physical examination during the same period.111 normal healthy prepubertal children who had not received rh GH treatment were used as the healthy control group.Monitor the height,weight,GV,Ht SDS,BMI values of the control group and the ISS group before and 12 months after treatment,and detect blood uric acid levels and IGF-1Concentration.Analyze the changes of blood uric acid levels before and after treatment in the ISS group and their correlation with other growth indicators.The statistical method of analyzing the data adopts IBM SPSS 26.0 software.The count data is represented by n（%）,using theχ²test;the mean±standard deviation is used to represent the measurement data,and the independent sample t-test is used to compare the means between the two groups;the analysis of variance with repeated measures design is used to analyze the results before and after treatment.The Pearson correlation analysis method was used for correlation analysis.P<0.05 indicates that the difference is statistically significant.Results1.Before treatment,Ht,Wt,GV,BMI,Ht SDS,and IGF-1 in the ISS group were significantly lower than those in the control group,and the difference was statistically significant（P<0.05）;the blood uric acid level was higher than the control group,and the difference was not statistically significant（P>0.05）.2.In the ISS group 12 months after treatment,Ht,Wt,BMI,GV,Ht SDS,IGF-1,and blood uric acid levels were higher than before treatment,but the blood uric acid levels were within the normal range,and the differences were statistically significant（all P<0.05）.3.（1）The blood uric acid level before treatment in the ISS group was not correlated with GV and Ht SDS（P>0.05）,but was positively correlated with Ht,Wt,BMI,and IGF-1（correlation coefficients were r=0.197,0.264,0.249,respectively）0.189;all P<0.05);（2）12 months after treatment,the blood uric acid level has no correlation with Ht,GV,Ht SDS,IGF-1（P>0.05）,but has a positive correlation with Wt and BMI（correlation coefficient）Respectively r=0.180,0.257,P<0.05).Conclusions1.The height of children with ISS before puberty after 12 months of rh GH treatment has been significantly improved.2.The blood uric acid level of prepubertal ISS children with rh GH treatment for12 months increased within the normal range,and it was positively correlated with the Wt and BMI values after treatment.3.The blood uric acid level of 12 months of rh GH treatment in prepubertal ISS children has no correlation with the Ht,GV,Ht SDS,IGF-1 after treatment.rh GH treatment will not affect the blood uric acid level in the body,and the increase of blood uric acid level does not Will affect linear growth.