Bone disease in patients receiving growth hormone.
Bone disease in patients receiving growth hormone.
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接受生长激素的患者出现骨病。
DOI：
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发表时间：
1996
期刊：
影响因子：
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通讯作者：
S. Watkins
中科院分区：
文献类型：
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作者：
S. Watkins
最近重组生长激素 (GH) 的使用扩大到非 GH 缺乏的患者，需要密切关注这些患者可能出现的并发症，包括对骨骼的影响，最近关于在慢性肾功能衰竭 (CRF) 儿童中使用 GH 的研究提供了一些早期数据。动物模型证明 GH 刺激软骨细胞增殖。实验数据进一步表明GH可以削弱骨骺板。据报道，在 GH 缺乏的患者中，股骨头骨骺滑脱 (SCFE) 在 GH 治疗之前、期间和之后均被检测到。在 CRF 患者中也有接受 GH SCFE 治疗的报道。由于肾性骨营养不良 (ROD) 和低钙血症是这种情况的危险因素，因此此类患者与 GH 治疗的关系尚不清楚。已有先天性肾结构异常儿童和接受 GH 治疗的 GH 缺乏患者发生股骨头缺血性坏死 (AVN) 的报道。最近对 200 多名 CRF 儿童进行的研究中，在接受治疗的患者中发现了 15 例 AVN 病例。治疗前有八人在场；另外 7 名患者在治疗前未接受放射学检查，因此与 GH 的关系尚不清楚。在几项 CRF 中 GH 的研究中，治疗组和未治疗组之间的放射学骨营养不良评分、血清钙、磷或甲状旁腺激素 (PTH) 水平没有发现显着差异。碱性磷酸酶短暂升高。 ROD 对生长反应的影响尚未有报道。使用 GH 治疗的 CRF 儿童应通过系列 X 线照片以及血清钙、磷、碱性磷酸酶和 PTH 水平连续监测 AVN、SCFE 和 ROD。
Recent expansion of the use of recombinant growth hormone (GH) to non-GH-deficient patients demands close attention to possible complications in these patients, including effects on bone, recent studies on the use of GH in children with chronic renal failure (CRF) provide some early data. Animal models demonstrate that GH stimulates chondrocyte proliferation. Experimental data further suggest that GH can weaken the epiphyseal plate. Slipped capital femoral epiphysis (SCFE) has been reported in GH-deficient patients, having been detected before, during and after GH therapy. In CRF patients treated with GH SCFE has also been reported. As renal osteodystrophy (ROD) and hypocalcemia are risk factors for this condition, the relationship to GH therapy is unclear in this type of patient. Avascular necrosis (AVN) of the femoral head has been reported in children with congenial structural renal abnormalities and GH deficient patients treated with GH. In recent studies in over 200 children with CRF, 15 cases of AVN have been identified in treated patients. Eight were present prior to treatment; the other 7 patients were not examined radiographically prior to their treatment, and thus the relationship to GH is unknown. In several studies of GH in CRF no significant differences in radiographic osteodystrophy scores, serum calcium, phosphorus or parathyroid hormone (PTH) levels between treated and untreated groups have been found. Alkaline phosphatase increases transiently. The effect of ROD on growth response has not yet been reported. Children with CRF treated with GH should be serially monitored for AVN, SCFE and ROD with serial radiographs and serum calcium, phosphorus, alkaline phosphatase and PTH levels.