生长激素治疗生长激素缺乏症儿童对骨代谢的影响及其相关性研究

摘要

目的：研究生长激素治疗对生长激素缺乏症（ GHD）患儿骨代谢的影响及其相关性。方法选取30例GHD儿童作为研究对象，按照0.03 mg/kg的剂量给予皮下注射重组人生长激素。观察患儿经治疗3个月和6个月后的血清胰岛素样生长因子-1（IGF-1）、胰岛素样生长因子结合蛋白3（IGF-BP3）、血清钙磷水平和骨转化指标的变化，经治疗6个月后测定其骨龄、腰椎和髋部骨密度的变化，并与治疗前相比较。结果治疗后3个月和治疗后6个月的IGF-1、IGFBP3、骨形成指标（AKP和OC）和骨吸收指标（CTX）较治疗前明显增加（ P ﹤0.05）。治疗前后血钙水平差异无统计学差异。治疗后3个月和治疗后6个月的血磷与治疗前相比显著升高（ P ﹤0.05）。骨密度增加与身高、血钙和IGF-BP3的变化具有正相关关系。IGFBP3水平与骨形成指标（ OC和AKP）呈正相关，骨形成指标（ OC）和骨吸收指标（ CTX）呈正相关。结论生长激素治疗GHD患儿能显著提高其IGF-1、IGF-BP3水平，促进钙磷吸收，加快骨转换，显著提高腰椎和髋部的骨密度。腰椎骨密度增加与治疗前后身高增加、血钙升高和IGF-BP3水平提高有关。%Objective To investigate the effects and correlations of growth hormone( GH)replacement therapy on the bone metabolism in children with growth hormone deficiency( GHD). Methods Thirty cases of GHD children in our hospital were selected as the research object. The serum of IGF-1,IGF-BP3,calcium,phosphonium,alkaline phosphatase,osteocalcin,β-CTX were observed after 3,6 months of treat-ment. The bone age,bone mineral density of lumbar spine and femoral bone were detected after 6 months of treatment. Results After 3 months and 6 months of treatment. The bone turnover markers( AKP,OC andβ-CTX),IGF-1 and IGF-BP3 were significantly increased compared with those before treatment( P ﹤0. 05). There was no statistical significance between the serum calcium levels before and after treatment. Serum phosphonium was significantly increased after GH therapy than before( P ﹤0. 01). The BMD of lumbar spine,neck of femur and great femur tro-chanter was significantly increased after GH therapy than before( P ﹤0. 01). The accrescence of lumbar spine BMD could be positively correlated with the increase of body height,serum calcium and IGF-BP3. IGFBP3 and bone formation index(OC and AKP)were positively correlated,and the bone formation index( OC)and bone resorption index( CTX)were positively correlated. Conclusion GH replacement therapy could improve the body height and growth velocity of GHD,promote absorption of calcium and phosphonium,increase the level of serum IGF-1,IGF-BP3 and the bone mineral density of spine and femur. The accrescence of lumbar spine BMD could be positively correlated with the increased changes of body height,serum calcium and IGF-BP3.