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目的探讨低剂量基因重组人生长激素(rhGH)治疗颅咽管瘤术后生长激素缺乏症(GHD)患儿的疗效和安全性。方法回顾性分析2008年4月-2011年4月在北京三博脑科医院内分泌门诊治疗的12例7～15岁术后病理确诊为颅咽管瘤且继发生长迟滞患儿的病例资料及随访资料。患儿均给予rhGH治疗(每晚睡前皮下注射0.1 IU.kg-1,每周5次注射),疗程3～36个月。定期检测肝功能、肾功能、激素水平等指标,并比较患儿治疗前后身高、体质量、生长速度、身高标准差计数、胰岛素样生长因子1(IGF-1)、骨龄等生长指标的改变。结果在rhGH治疗期间,12例患儿在治疗第1年生长速率增加显著,由(2.2±1.3)cm.a-1增加到(6.63±4.97)cm.a-1(P<0.01),身高标准差计数由治疗前-3.3±2.3增加到-3.2±2.8,血IGF-1治疗前为(38±64)μg.L-1,治疗后为(173±167)μg.L-1(患儿治疗后血清IGF-1水平达到正常范围),差异均有统计学意义(Pa<0.01)。治疗期间,患儿肝肾功能等均保持在正常值范围,骨龄无明显变化,随访时尚无患儿肿瘤复发。结论低剂量rhGH治疗儿童颅咽管瘤术后继发GHD是经济、有效的,在充分评估及严密监控下开展GH替代治疗是安全的。
Objective To investigate the efficacy and safety of low-dose recombinant human growth hormone (rhGH) in the treatment of children with growth hormone deficiency (GHD) after craniopharyngioma surgery. Methods The clinical data of 12 children aged 7-15 years with pathological diagnosis of craniopharyngioma with secondary delayed hysteronychitis from April 2008 to April 2011 were retrospectively analyzed. Follow-up information. Children were given rhGH treatment (0.1 IU.kg-1 subcutaneously before going to bed every night, 5 times a week injection), course of 3 to 36 months. The liver function, renal function, hormone level and other indexes were detected regularly. The changes of height, body weight, growth rate, standard deviation count, insulin-like growth factor 1 (IGF-1) and bone age were compared before and after treatment. Results During the rhGH treatment, the growth rate of the 12 children in the first year of treatment increased significantly from (2.2 ± 1.3) cm.a-1 to (6.63 ± 4.97) cm.a-1 (P <0.01) The standard deviation was increased from -3.3 ± 2.3 to -3.2 ± 2.8 before treatment and (38 ± 64) μg.L-1 before treatment with IGF-1 and 173 ± 167 μg.L-1 after treatment After treatment, serum IGF-1 levels reached the normal range), the differences were statistically significant (Pa <0.01). During treatment, children with liver and kidney function were maintained within the normal range, no significant change in bone age, no tumor recurrence at follow-up. Conclusion Low dose rhGH for the treatment of children with craniopharyngioma secondary to postoperative GHD is an economical and effective, under the full evaluation and close monitoring of GH replacement therapy is safe.