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生长激素缺乏症与生长激素激发试验
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Abstract:
生长激素缺乏症可导致儿童身材矮小，是小儿矮小症重要病因之一，现已受到越来越多儿科内分泌医生的关注，及时应用重组生长激素替代治疗可以有效改善患儿终身高。生长激素激发试验是诊断生长激素缺乏症的重要方法，更多认识生长激素激发试验才能更好地在临床中诊断生长激素缺乏症。生长激素激发试验已有很多临床研究，不同激发试验生长激素峰值存在不同，体质指数与生长激素峰值呈负相关。生长激素激发试验判读阈值现国内外无统一标准，部分国家已经下调诊断阈值，我国现仍沿用10 ug/L的诊断阈值。
Growth hormone deficiency can cause childhood short stature and is one of the major causes of pediatric short stature. It has increasingly attracted the attention of pediatric endocrinologists. Timely application of recombinant human growth hormone replacement therapy can effectively improve the final height of affected children. The growth hormone stimulation test is an important method for diagnosing growth hormone deficiency, and a deeper understanding of this test can better facilitate the clinical diagnosis of growth hormone deficiency. There have been many clinical studies on the growth hormone stimulation test, and different tests have shown varying peak growth hormone levels. Body mass index is negatively correlated with peak growth hormone levels. Currently, there is no unified standard for interpreting the threshold values of the growth hormone stimulation test, and some countries have already lowered the diagnostic threshold. However, in China, the diagnostic threshold of 10 ug/L is still being used.
| [1] | 中华医学会儿科学分会内分泌遗传代谢学组, 《中华儿科杂志》编辑委员会, 梁雁. 基因重组人生长激素儿科临床规范应用的建议[J]. 中华儿科杂志, 2013, 51(6): 426-432. |
| [2] | 中华医学会儿科学分会内分泌遗传代谢学组. 矮身材儿童诊治指南[J]. 中华儿科杂志, 2008, 46(6): 428-430. |
| [3] | Hou, L., Liang, Y., Wu, W., Lin, H., Luo, X. and Ying, Y. (2020) Comparison of the Efficacy and Safety of Recombinant Human Growth Hormone in Treating Idiopathic Short Stature and Growth Hormone Deficiency in Children. Growth Hormone & IGF Research, 53, Article ID: 101331. https://doi.org/10.1016/j.ghir.2020.101331 |
| [4] | 张艳芳, 韩雪. 生长激素缺乏症对心血管系统病变的影响分析[J]. 数理医药学杂志, 2019, 32(1): 56-57. |
| [5] | 陈佳佳, 曹冰燕, 巩纯秀, 等. 儿童特发性矮身材诊断与治疗中国专家共识[J]. 中国实用儿科杂志, 2023, 38(11): 801-813. |
| [6] | Ibba, A. and Loche, S. (2022) Diagnosis of GH Deficiency without GH Stimulation Tests. Frontiers in Endocrinology, 13, Article ID: 853290. https://doi.org/10.3389/fendo.2022.853290 |
| [7] | Dror, N., Pantanowitz, M., Nemet, D. and Eliakim, A. (2021) High-Intensity Interval Exercise Test Stimulates Growth Hormone Secretion in Children. Growth Hormone & IGF Research, 57, Article ID: 101388. https://doi.org/10.1016/j.ghir.2021.101388 |
| [8] | Allen, D.B. (2021) Diagnosis of Growth Hormone Deficiency Remains a Judgment Call—And That Is Good. Hormone Research in Paediatrics, 94, 406-409. https://doi.org/10.1159/000521628 |
| [9] | 李蕾, 卢园园, 王倩倩, 等. 溴吡斯的明与可乐定联合激发试验对儿童生长激素缺乏症的诊断价值[J]. 中国医药科学, 2022, 12(12): 139-142. |
| [10] | Donbalo？lu, Z., Singin, B., Acar, S., Bedel, A., Barsal ？etiner, E., Ayd？n Behram, B., et al. (2023) Evaluation of the Growth Response of Children with Growth Hormone Deficiency According to the Peak Growth Hormone Levels in Provocation Tests. Archives de Pédiatrie, 30, 573-579. https://doi.org/10.1016/j.arcped.2023.08.005 |
| [11] | 陈瑞敏, 艾转转, 蔡彬彬. 生长激素治疗儿童特发性矮身材的研究进展[J]. 中国实用儿科杂志, 2023, 38(11): 838-842. |
| [12] | 陈龙. 生长激素缺乏症与特发性矮身材儿童血清IGF-1及25-(OH)D水平变化的研究[D]: [硕士学位论文]. 石家庄: 河北医科大学, 2016. |
| [13] | Ibba, A., Guzzetti, C., Casula, L., Salerno, M., Di Iorgi, N., Allegri, A.M.E., et al. (2018) Reliability of Clonidine Testing for the Diagnosis of Growth Hormone Deficiency in Children and Adolescents. Clinical Endocrinology, 89, 765-770. https://doi.org/10.1111/cen.13845 |
| [14] | Bhat, N., Dulmovits, E., Lane, A., Messina, C. and Wilson, T. (2018) Combined Simultaneous Arginine Clonidine Stimulation Test: Timing of Peak Growth Hormone (GH) Concentration and Correlation with Clinical Indices of GH Status. Growth Hormone & IGF Research, 40, 28-31. https://doi.org/10.1016/j.ghir.2018.04.002 |
| [15] | Abawi, O., Augustijn, D., Hoeks, S.E., de Rijke, Y.B. and van den Akker, E.L.T. (2021) Impact of Body Mass Index on Growth Hormone Stimulation Tests in Children and Adolescents: A Systematic Review and Meta-Analysis. Critical Reviews in Clinical Laboratory Sciences, 58, 576-595. https://doi.org/10.1080/10408363.2021.1956423 |
| [16] | Kim, J.H., Chae, H.W., Chin, S.O., Ku, C.R., Park, K.H., Lim, D.J., et al. (2020) Diagnosis and Treatment of Growth Hormone Deficiency: A Position Statement from Korean Endocrine Society and Korean Society of Pediatric Endocrinology. Endocrinology and Metabolism, 35, 272-287. https://doi.org/10.3803/enm.2020.35.2.272 |
| [17] | Oron, T., Krieger, A., Yakobovich-Gavan, M., Tenenbaum, A., Diamant, R., Phillip, M., et al. (2022) Diagnosing Growth Hormone Deficiency: Can a Combined Arginine and Clonidine Stimulation Test Replace 2 Separate Tests? Endocrine Practice, 28, 36-43. https://doi.org/10.1016/j.eprac.2021.08.004 |
| [18] | Castagno, M., Monzani, A., Zanetta, S., Genoni, G., Giglione, E., Ricotti, R., et al. (2018) Evaluation of Growth Hormone Response to GHRH plus Arginine Test in Children with Idiopathic Short Stature: Role of Peak Time. Journal of Endocrinological Investigation, 41, 977-983. https://doi.org/10.1007/s40618-017-0824-6 |
| [19] | Dori, E.B., Avnon Ziv, C., Auerbach, A., Greenberg, Y., Zaken, H. and Levy-Khademi, F. (2020) The Inter-Test Variability of Growth Hormone Stimulation Tests and Factors Affecting This Variability. Growth Hormone & IGF Research, 55, Article ID: 101361. https://doi.org/10.1016/j.ghir.2020.101361 |
| [20] | Penta, L., Cofini, M., Lucchetti, L., Zenzeri, L., Leonardi, A., Lanciotti, L., et al. (2019) Growth Hormone (GH) Therapy during the Transition Period: Should We Think about Early Retesting in Patients with Idiopathic and Isolated GH Deficiency? International Journal of Environmental Research and Public Health, 16, Article No. 307. https://doi.org/10.3390/ijerph16030307 |
| [21] | Tidblad, A. (2021) The History, Physiology and Treatment Safety of Growth Hormone. Acta Paediatrica, 111, 215-224. https://doi.org/10.1111/apa.15948 |
| [22] | Collett-Solberg, P.F., Ambler, G., Backeljauw, P.F., Bidlingmaier, M., Biller, B.M.K., Boguszewski, M.C.S., et al. (2019) Diagnosis, Genetics, and Therapy of Short Stature in Children: A Growth Hormone Research Society International Perspective. Hormone Research in Paediatrics, 92, 1-14. https://doi.org/10.1159/000502231 |
| [23] | Boguszewski, M.C.S. (2020) Growth Hormone Deficiency and Replacement in Children. Reviews in Endocrine and Metabolic Disorders, 22, 101-108. https://doi.org/10.1007/s11154-020-09604-2 |
| [24] | 晏文华, 张梅, 李萍, 等. 矮小症患儿生长激素激发试验峰值与BMI的相关研究[J]. 济宁医学院学报, 2018, 41(2): 97-101. |
| [25] | 周海群, 王丹, 孙丽芃, 等. 可乐定联合精氨酸激发试验在矮小儿童生长激素缺乏症中的诊断价值及生长激素峰值的影响因素分析[J]. 现代生物医学进展, 2019, 19(13): 2555-2558, 2575. |
| [26] | Yang, A., Cho, S.Y., Kwak, M.J., Kim, S.J., Park, S.W., Jin, D., et al. (2019) Impact of BMI on Peak Growth Hormone Responses to Provocative Tests and Therapeutic Outcome in Children with Growth Hormone Deficiency. Scientific Reports, 9, Article No. 16181. https://doi.org/10.1038/s41598-019-52644-1 |
| [27] | Yau, M., Chacko, E., Regelmann, M.O., Annunziato, R., Wallach, E.J., Chia, D., et al. (2019) Peak Growth Hormone Response to Combined Stimulation Test in 315 Children and Correlations with Metabolic Parameters. Hormone Research in Paediatrics, 92, 36-44. https://doi.org/10.1159/000502308 |
| [28] | Yau, M. and Rapaport, R. (2022) Growth Hormone Stimulation Testing: To Test or Not to Test? That Is One of the Questions. Frontiers in Endocrinology, 13, Article ID: 902364. https://doi.org/10.3389/fendo.2022.902364 |
| [29] | Cattoni, A., Molinari, S., Medici, F., De Lorenzo, P., Valsecchi, M.G., Masera, N., et al. (2020) Dexamethasone Stimulation Test in the Diagnostic Work-Up of Growth Hormone Deficiency in Childhood: Clinical Value and Comparison with Insulin-Induced Hypoglycemia. Frontiers in Endocrinology, 11, Article ID: 599302. https://doi.org/10.3389/fendo.2020.599302 |
| [30] | Galazzi, E., Improda, N., Cerbone, M., Soranna, D., Moro, M., Fatti, L.M., et al. (2020) Clinical Benefits of Sex Steroids Given as a Priming Prior to GH Provocative Test or as a Growth‐Promoting Therapy in Peripubertal Growth Delays: Results of a Retrospective Study among ENDO‐ERN Centres. Clinical Endocrinology, 94, 219-228. https://doi.org/10.1111/cen.14337 |
| [31] | Grimberg, A., DiVall, S.A., Polychronakos, C., Allen, D.B., Cohen, L.E., Quintos, J.B., et al. (2016) Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency. Hormone Research in Paediatrics, 86, 361-397. https://doi.org/10.1159/000452150 |
| [32] | Ranke, M.B. (2021) Short and Long-Term Effects of Growth Hormone in Children and Adolescents with GH Deficiency. Frontiers in Endocrinology, 12, Article ID: 720419. https://doi.org/10.3389/fendo.2021.720419 |
| [33] | Albrecht, A., Penger, T., Marx, M., Hirsch, K. and D？rr, H.G. (2017) Short-Term Adverse Effects of Testosterone Used for Priming in Prepubertal Boys before Growth Hormone Stimulation Test. Journal of Pediatric Endocrinology and Metabolism, 31, 21-24. https://doi.org/10.1515/jpem-2017-0280 |
| [34] | Radetti, G., Elsedfy, H.H., Khalaf, R., Meazza, C., Pagani, S., Kholy, M.E., et al. (2017) Pegvisomant-Primed Growth Hormone (GH) Stimulation Test Is Useful in Identifying True GH Deficient Children. Hormones, 16, 291-296. https://doi.org/10.1007/bf03401523 |
| [35] | Csákváry, V., Ammer, N., Bagci, E.B., Bolshova, O.V., Damholt, B.B., Katanic, D., et al. (2021) Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of Macimorelin in Children with Suspected Growth Hormone Deficiency: An Open-Label, Group Comparison, Dose-Escalation Trial. Hormone Research in Paediatrics, 94, 239-250. https://doi.org/10.1159/000519232 |
