Efficacy And Influencing Factors Of Therapy With RhGH On The Treatment Of Growth Hormone Deficiency And Idiopathic Short Stature In Children

Objective:To compare the therapeutic effects of recombinant human growth growth?rhGH?on growth hormone deficiency?GHD?and idiopathic short stature?ISS?in children with growth hormone deficiency?GHD?.To observe the changes of serum insulin-like growth factor?IGF-1?,thyroid hormone?TH?,fasting blood glucose?FBG?,fasting insulin?FINS?,bone age?BA?and growth velocity?GV?during the treatment of rhGH.To explore the factors influencing the therapeutic effect of rhGH,and provide better clinical guidance.Methods:Subjects were selected from children who were diagnosed as GHD and ISS and treated with rhGH.Finally 34 GHD children and 30 ISS children were selected.The dosages of rhGH for GHD and ISS were0.10-0.15IUU/?kg?d?and 0.10-0.20IUU/?kg?d?.rh GH was administered by subcutaneous injection in bed time everyday.The observation indicators include before treatment,after 3 months and 6 months of treatment,height?Ht?,weight?Wt??body mass index?BMI?,growth velocity?GV?,height standard deviation of points?HtSDS?,mid-parental height?MPH?,bone age backwardness?CA-BA?,bone age maturity?BA/CA?,serum total three iodide thyroidic acid?TT3?,total four iodine thyroidic acid?TT4?,thyroid-stimulating hormone?TSH?,IGF-1,FBG,and FINS.Result:1 Comparison between GHD group and ISS group before treatmentThe BA/CA was significantly lower in GHD group than that in ISS group?P<0.001?.CA-BA was significantly higher in GHD group than that in ISS group?P<0.001?.Age and gender matched in both groups?P>0.05?.The GH stimulating peak in GHD group was lower than that in ISS group?P<0.001?.There was no statistical difference in the remaining indicators?P>0.05?.2 Comparison of growth parameters and serological indicators before and after treatment in two groups2.1 Comparison of the growth parameters in two groups before and after treatmentAfter 3 months or 6 months of rhGH treatment,Ht,Ht SDS and GV in GHD group and ISS group were all higher than those before treatment?P<0.001?.Compared with those before treatment,BMI and BA/CA in two groups had no significant change?P>0.05?.The?Ht SDS was lower after 6 months of treatment than those after 3 months of treatment in two groups?P<0.05?.2.2 Comparison of the serological indicators in two groups before and after treatmentThe IGF-1,FBG and FINS were higher after 3 months and 6 months of treatment than those before treatment in two groups?P<0.05?.In GHD group,compared with before treatment,the TT3 was higher after 3 months of treatment?P<0.05?.There was no significant change in other thyroid functions?P>0.05?.In ISS group,the FBG had higher level after 6 months of treatment than that after 3 months of treatment?P<0.05?.there was no statistical difference in IGF-1,FINS and thyroid functions in other serological indicators?P>0.05?.In the GHD group,compared with after 3 months of treatment,there was no significant difference in above indicators after 6 months of treatment?P>0.05?.3 Comparison of growth parameters and serological indicators between GHD and ISS group during the same period of treatmentThe GV and?Ht were higher in GHD group than those in ISS group after 3 months and 6 months of treatment?P<0.05?.There was no significant difference of?HtSDS in two groups during the same period of treatment?P>0.05?.The TSH was higher in GHD group than that in ISS group after 6 months of treatment?P<0.05?.There was no significant difference in IGF-1,FBG,FINS,TT3 and TT4 during the same period of treatment?P>0.05?.4 Correlation analysis between growth velocity and clinical indicators in two groupsIn GHD group,GV₃ was negatively correlated with GH stimulating peak and IGF-1 before treatment.GV₆ was negatively correlated with GH stimulating peak.?Ht SDS₃ was negatively related with the IGF-1 before treatment.?HtSDS6 was negatively related with HtSDS before treatment and GH stimulating peak.In ISS group,GV₃ and GV₆ were positively correlated with the dose of GH,and negatively correlated with CA,BA and Ht before treatment.?HtSDS₃ was positively related with the dose of GH,and negatively related with CA,BA and Ht before treatment.?HtSDS₆ was negatively correlated with CA,BA,Ht and HtSDS before treatment.5 Analysis of factors influencing growth indicators in two groupsUsing multiple linear stepwise regression analysis,the results indicated that in GHD group,the GH stimulating peak was the important influencing factor of GV₆.In ISS group,the Ht before treatment was the important influencing factor of GV₆.In GHD group,the HtSDS before treatment was the important influencing factor of?Ht SDS₆.In ISS group,the Ht and CA before treatment were the important influencing factors of?Ht SDS₆.Conclusion:1 rhGH had a good therapeutic effect on GHD and ISS.The effect on GHD children was better than that on ISS children.Definitive diagnosis is very important to guide treatment and predict efficacy.2 In GHD group,the HtSDS before treatment and GH stimulating peak were the important influencing factors of curative effect.In ISS group,the Ht and CA before treatment were the important influencing factors of curative effect.3 Short-term application of rhGH will not increase weight and accelerate bone age.But it will slightly affect the thyroid function,blood glucose and insulin level.Therefore,we should monitor the change of these indicators regularly.