Effects On Growth And Metabolic Profile Of RhGH Or Combined Use Of RhGH And GnRHa In Children And Adolescents With Short Stature

CONTEXT AND OBJECTIVE:With the development of society and improvement of economic level,more attention is attracted to the pursuit of beauty and ideal height.Short stature affects self-esteem,daily life,career and marriage.Thus children and adolescents with short stature and their families have a strong need to improve their height.Effect of recombinant human growth hormone(rhGH)alone or combined with gonadotropin-releasing hormone analogue(GnRHa)treatment in children and adolescents with short stature is still controversial.A few studies focused on metabolic changes during rhGH treatment,such as glucose metabolism,lipid metabolism,and thyroid function.Little is known about the metabolic effects of rhGH combined with GnRHa treatment in short stature.This article aims to analyze the efficacy of rhGH alone or combined with GnRHa in children and early puberty and the metabolic changes during treatment.METHODS:62 children and adolescents with short stature treated with rhGH alone or combined with GnRHa were enrolled.Prepubertal patients were treated with rhGH.Pubertal patients were treated with rhGH combined with GnRHa.A small portion of patients in early stage of puberty were treated with rhGH alone,considering their optimistic growth potential.Patients were followed up once every 3-6 months.Height,fasting blood glucose,fasting insulin,blood lipids,thyroid function,liver enzymes and other indicators were monitered.RESULTS:1.In rhGH group,compared to iniciation of treatment and 6 months of treatment,HtSDSCA at 12 months after treatment increased(p = 0.001).But there was no significant difference in HtSDSBA before and after treatment.PAH increased by 1.7cm at 12 months after treatment.In combined therapy group,compared to iniciation of treatment and 6 months of treatment,HtSDSCA and HtSDSBA at 12 months after treatment significantly increased(p = 0.022).PAH increased by 6.4 cm at 12 months after treatment.2.In rhGH group,no significant difference in FBG,FINS,HOMA-IR,TC,TG,HDL-C and TG/HDL-C before and after treatment was observed.LDL-C decreased(12m p =0.043).ALT(6m p = 0.041)and AST(6m p = 0.028)decreased.After treatment,FT3 increased(6m p = 0.020);FT4 decreased first and then increased(3m p = 0.014).There was no significant difference in TSH before and after treatment.In combined therapy group,FBG,FINS and HOMA-IR increased after treatment(12m FBG p = 0.027;FINS p = 0.028;HOMA-IR p = 0.028).TC,TG,LDL-C,HDL-C TG/HDL-C was not significantly different from that before treatment.Compared to before,ALT after 3 months of treatment increased(p = 0.042),but was still in the normal range;AST was similar with that before treatment.FT3 and FT4 was not significantly different from that before treatment.TSH decreased(p = 0.028)at 9 months after treatment.3.Patients in similar puberty stage from the two groups were analyzed(n=20,rhGH alone group n=11,rhGH combined with GnRHa group n=9).There was no significant difference in HtSDSBA,PAH,IGF-1 and the metabolic indexes between the two groups.After treatment,IGF-1 and GV were higher in rhGH alone group(IGF-1 6m p = 0.018;GV 3m p = 0.011).GV was associated with GnRHa treatment.After treatment,there was no significant difference in HtSDSBA,PAH,HOMA-IR,TG/HDL,ALT,AST,FT3,FT4,FT3/FT4 and TSH between the two groups.CONCLUSION:Treatment with rhGH alone or combined with GnRHa in children and adolescents with short stature can improve PAH.Compared with rhGH therapy,similar efficacy of short-term use of rhGH combined with GnRHa in adolescentss with short stature was observed.The two therapies showed similar effects on insulin sensitivity,blood lipid,transaminase and thyroid function.