Growth hormone treatment for growth hormone deficiency and idiopathic short stature: new guidelines shaped by the presence and absence of evidence.
Growth hormone treatment for growth hormone deficiency and idiopathic short stature: new guidelines shaped by the presence and absence of evidence.
复制标题
生长激素治疗生长激素缺乏症和特发性短期：由存在和不存在证据所塑造的新指南。
DOI：
10.1097/mop.0000000000000505
复制
发表时间：
2017-08
影响因子：
3.6
通讯作者：
Allen DB
中科院分区：
文献类型：
--
作者：
Grimberg A;Allen DB
儿科内分泌学会最近发布了使用生长激素（hGH）和胰岛素样生长因子- 1 （higf - 1）治疗儿童和青少年生长激素缺乏症（GHD）、特发性身材矮小（ISS）和原发性igf - 1缺乏症（PIGFD）的新指南。本综述将新指南置于hGH生命周期的历史背景和美国医疗保健的演变中，并强调其未来的意义。新的hGH指南，第一个由GRADE方法创建的指南，比他们的前辈更加保守。当美国医疗保健转向以价值为基础的实践时，他们遵循了长时间的生长激素治疗扩展。关于恢复生长激素或igf - 1严重缺乏儿童的激素正常，有强有力的支持证据和普遍的共识。更复杂的是与hGH治疗有关的问题，以提高生长速度和身高，否则健康的矮个子儿童患有ISS或“部分”孤立的特发性GHD。制定指南的过程揭示了一些关于hGH治疗的基本问题，这些问题仍然需要基于证据的答案。除非进行这样的研究，否则更有节制的hgh处方方法是合适的。
The Pediatric Endocrine Society recently published new guidelines for the use of growth hormone (hGH) and insulin-like growth factor-I (hIGF-I) treatment for GH deficiency (GHD), idiopathic short stature (ISS) and primary IGF-I deficiency (PIGFD) in children and adolescents. This review places the new guidelines in historical contexts of the life cycle of hGH and the evolution of U.S. health care, and highlights their future implications. The new hGH guidelines, the first to be created by the GRADE approach, are more conservative than their predecessors. They follow an extended period of hGH therapeutic expansion at a time when U.S. health care is pivoting towards value-based practice. There are strong supporting evidence and general agreement regarding the restoration of hormonal normalcy in children with severe deficiency of GH or IGF-I. More complex are issues related to hGH treatment to increase growth rates and heights of otherwise healthy short children with either ISS or “partial” isolated idiopathic GHD. The guidelines-developing process revealed fundamental questions about hGH treatment that still need evidence-based answers. Unless and until such research is performed, a more restrained hGH-prescribing approach is appropriate.