Metabolic Impact of Growth Hormone Treatment in Short Children Born Small for Gestational Age
Metabolic Impact of Growth Hormone Treatment in Short Children Born Small for Gestational Age
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DOI：
10.1159/000329729
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发表时间：
2011-01-01
影响因子：
3.2
通讯作者：
Phillip, Moshe
中科院分区：
文献类型：
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作者：
Lebl, Jan;Lebenthal, Yael;Phillip, Moshe
背景资料：生长激素（GH）治疗出生小于胎龄儿（SGA）的矮小儿童可能会导致代谢变化，具有潜在的长期影响。研究方法：149名矮小SGA儿童（平均出生体重2.0 ± 0.6 kg，年龄5.5 ± 1.5岁，身高标准差评分（SDS）-3.1 ± 0.6）随机分配至：低剂量GH治疗组（0.033 mg/kg/d）治疗2年;高剂量GH治疗（0.100 mg/kg/d）治疗1年，或中剂量GH治疗（0.067 mg/kg/d）治疗1年。在基线、12个月和24个月时评估瘦素、生长激素释放肽、胰岛素样生长因子-I（IGF-I）、胰岛素样生长因子结合蛋白-1（IGFBP-1）、血脂、空腹血糖和空腹胰岛素。结果：GH治疗1年后，血清ghrelin水平明显降低，IGF-I SDS和胰岛素水平明显升高。回归分析显示ghrelin与IGF-I SDS呈负相关（p < 0.001）。瘦素和IGFBP-1也下降（均p < 0.05）。胰岛素水平的变化在停药后逆转。血脂的改善不显著，空腹血糖水平保持在正常范围内。结论：在短SGA儿童，生长激素释放肽和瘦素减少与GH治疗可能会发生通过GH-IGF-I轴的负反馈回路。因此，通过生长激素释放肽和瘦素抑制，生长激素治疗可能会改变食物摄入量和身体组成，并可能改善长期代谢结果。版权所有（C）2011 S. Karger AG，巴塞尔
Background: Growth hormone (GH) treatment in short children born small for gestational age (SGA) may result in metabolic changes with potential long-term effects. Methods: 149 short SGA children (mean birth weight 2.0 +/- 0.6 kg, age 5.5 +/- 1.5 years, height standard deviation score (SDS) -3.1 +/- 0.6) were randomised to: low-dose GH therapy (0.033 mg/kg/day) for 2 years; high-dose GH therapy (0.100 mg/kg/day) for 1 year, or mid-dose GH therapy (0.067 mg/kg/day) for 1 year. Leptin, ghrelin, insulin-like growth factor-I (IGF-I), IGF binding protein-1 (IGFBP-1), lipids, fasting blood glucose and fasting insulin were assessed at baseline, 12 and 24 months. Results: After 1 year of active treatment, GH significantly reduced serum ghrelin and increased IGF-I SDS and insulin levels. Regression analysis showed an inverse correlation between ghrelin and IGF-I SDS (p < 0.001). Leptin and IGFBP-1 also declined (both p < 0.05). Changes in insulin levels reversed upon discontinuation. Improvements in lipid profile were nonsignificant and fasting blood glucose levels remained within the normal range. Conclusion: In short SGA children, ghrelin and leptin reductions associated with GH treatment may occur through a negative feedback loop of the GH-IGF-I axis. Consequently, via ghrelin and leptin suppression, GH treatment may modify food intake and body composition and potentially improve long-term metabolic outcomes. Copyright (C) 2011 S. Karger AG, Basel