重组人生长激素治疗对生长激素缺乏症患者甲状腺功能的影响  

THE EFFECT OF RECOMBINANT HUMAN GROWTH HORMONE ON THYROID FUNCTION IN PATIENTS WITH GROWTH HORMONE DEFICIENCY

作　　者：唐丹[1] 王峻峰[1] 吴从愿[1] 邓洁英[1] 史轶蘩[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院内分泌科

出　　处：《中华内科杂志》1997年第11期754-758,共5页Chinese Journal of Internal Medicine

摘　　要：为探讨生长激素治疗对甲状腺功能的影响及其机制，给１９例特发性生长激素缺乏症患者每日皮下注射重组人生长激素（ｒｈＧＨ）Ｇｅｎｏｔｒｏｐｉｎ０．１ＩＵ／ｋｇ体重，治疗１年，观察治疗前后甲状腺功能及血促甲状腺激素（ＴＳＨ）对静脉推注促甲状腺素释放激素（ＴＲＨ）的反应。经Ｇｅｎｏｔｒｏｐｉｎ治疗后，患者血清Ｔ４及ＦＴ４水平较治疗前明显下降（Ｐ＜０．０１）；治疗半年后，血清ＦＴ３水平亦较治疗前下降（Ｐ＜０．０５）；而血清Ｔ３、３，３′，５′－三碘甲状腺原氨酸及ＴＳＨ水平无明显变化（０．２＜Ｐ＜０．３）。治疗１年后，８例患者血清ＦＴ４水平降至正常范围以下，依此将患者分为治疗后甲状腺功能正常组及降低组，结果证实甲状腺功能降低组在治疗前或治疗后ＴＳＨ对ＴＲＨ兴奋的反应均较甲状腺功能正常组高（Ｐ＜０．０５）。血清ＴＳＨ对ＴＲＨ的反应增强提示患者治疗前就已有潜在的ＴＲＨ缺乏，后者可能是ｒｈＧＨ治疗过程中ＦＴ４及Ｔ４水平下降的潜在基础。因此在ｒｈＧＨ治疗过程中需监测特发性生长激素缺乏症患者的甲状腺功能，以及时给予替代治疗。To evaluate the effect of growth hormone treatment on thyroid function of growth hormone deficient children, 19 (18M/1F) euthyroid children of growth hormone deficiency (GHD) were treated with Genotropin, a recombinant human growth hormone (rhGH) for 12 months. rhGH was injected subcutaneously with a daily dosage of 0.1 IU/kg. All the patients were diagnosed by two GH provocative stimulating tests with the serum GH peak level <7 μg/L. During the treatment, blood was drawn before or 6 and 12 months after the initiation of therapy to measure serum T3, T4, FT3, FT4, rT3 and thyroidstimulating hormone (TSH) levels. In the meantime, thyrotropin releasing hormone (TRH) stimulating test was performed by an i.v. injection of 200 μg synthetic TRH. The results showed that (1) the average serum levels of T4 and FT4 decreased significantly 6 at the 6th and 12th month (P<0.001), while the serum FT3 level decreased only at the 6th month (P<0.05). The serum T3, rT3 and TSH concentrations remained unchanged. (2) 8 euthyroid patients (45%) became subclinical hypothyroidism after 12 months′ treatment with rhGH for their serum FT4 levels fell to below the normal range. The 19 patients were divided into thyroid function normal (n=11) and subnormal group (n=8) according to their posttreatment thyroid functions. (3) The TSH response to TRH was evaluated by the area under the curve (AUC) of serum TSH. The average AUC was greater in the subnormal group than in the normal group whether before or 6 and 12 months after the treatment. The greater TSH response to TRH among patients with decreased posttreatmental FT4 levels suggests that latent TRH deficiency has already existed, which may be the pathogenetic basis of the hypothyroidism developped after rhGH treatment. Thus the thyroid function of GHD patients should be monitored during rhGH treatment in order that the thyroxine replacement therapy can be given in time.

关 键 词：促生长素 侏儒症 甲状腺功能减退 治疗 

分 类 号：R581.205[医药卫生—内分泌]