A Quantitative Efficacy Study Of Recombinant Human Growth Hormone In The Treatment Of Dwarfism

Objective: To observe the appropriate dose and efficacy of recombinant human growth hormone(rh GH)in prepubertal and adolescent patients with different etiologies of dwarfism,and to provide a reference basis for seeking optimal treatment and shortening treatment time.Methods: Patients with dwarfism diagnosed in the outpatient clinic of a hospital from September 2020 to September 2022 and followed up in the outpatient clinic of the hospital for more than one year were selected based on different etiologies and also based on long-term follow-up in the outpatient clinic.We also collected 121 cases of Idiopathic short stature(ISS),48 cases of Growth hormone deficience(GHD),41 cases of Central precocious puberty(CPP)and 24 cases of Turner syndrome(TS).The patients in the ISS and GHD groups were divided into prepubertal(Tanner I)and pubertal(Tanner II-IV)groups according to the Tanner staging criteria.The CPP group was divided into prepubertal group and pubertal group according to the combination of gonadotropin releasing hormone agonist(Gn RHa)treatment.The TS group were divided into prepubertal and pubertal groups according to whether they were treated with combination drugs.The dose of injection was started from 0.15 IU/kg/d and the observation period was 1 year.The Main indicators: dose,weight(Wt),height(Height,Ht),genetic target height(TH),bone age(BA),growth velocity(GV),height standard deviation(Height SDS,Ht SDS),weight standard deviation(Weight SDS,Wt SDS),insulin-like growth factor-1(IGF-1),etc.Results: 1.The applied doses of rh GH in the four groups with different etiologies of dwarfism were as follows: ISS group: prepubertal group,(0.17±0.024)IU/kg/d;pubertal group,(0.19±0.017)IU/kg/d.GHD group: prepubertal group,(0.16±0.021)IU/kg/d;pubertal group,(0.19±0.012)IU/kg/d.TS group: prepubertal group,(0.16±0.024)IU/kg/d;pubertal group,(0.20±0.010)IU/kg/d.CPP group:(0.18±0.026)IU/kg/d.Except for the CPP group,the remaining three groups were compared with the prepubertal group and the pubertal group,P<0.05,and the difference was statistically significant.2.After two-by-two analysis of the LSD experimental method for the prepubertal group,the ISS group was compared with the GHD group and the TS group,P<0.05.The difference between GHD group and ISS group and CPP group was statistically significant with P < 0.05.The remaining two-by-two comparisons were not statistically significant.3.The treatment response to rh GH in the GHD and ISS groups before puberty versus puberty was statistically significant at P< 0.05.The difference was not statistically significant in the TS group before puberty versus puberty at P > 0.05.4.Before puberty,comparingΔGV,ΔHt SDS and ΔIGF-1 in the ISS and GHD groups,the difference was statistically significant,P < 0.05.Conclusion: 1.The applied doses of rh GH in the four groups with different etiologies of dwarfism before puberty and at puberty were: ISS group: 0.17 IU/kg/d,0.19 IU/kg/d;GHD group: 0.16 IU/kg/d,0.19IU/kg/d;TS group: 0.16 IU/kg/d,0.20 IU/kg/d;CPP group: 0.18 IU/kg/d.2.The treatment response to rh GH was different in the ISS and GHD groups before puberty and during puberty.Pre-pubertal initiation of treatment was better;pubertal patients in the TS group with combined drugs use could obtain the same efficacy as pre-pubertal patients.3.Pre-pubertal GHD patients with smaller doses of rh GH compared to ISS had better efficacy.