成人生长激素缺乏症诊断与治疗指南解读  

Interpretation of guidelines on the diagnosis and treatment of adults with growth hormone deficiency

作　　者：岑晶[1] 顾锋[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院内分泌科卫生部内分泌重点实验室,北京100730

出　　处：《中国实用内科杂志》2011年第8期608-612,共5页Chinese Journal of Practical Internal Medicine

摘　　要：成人生长激素缺乏症(GHD)最常见于下丘脑和(或)垂体结构破坏或功能损害,临床上主要根据一系列非特异性临床表现及相应的生化指标来确诊。由于生长激素(GH)的脉冲式分泌及正常人群随机GH测定值的波动,GHD患者不能仅依据随机GH结果与正常人群相鉴别。目前国际上公认的成人GHD诊断金标准是胰岛素低血糖试验(ITT),近年来认为生长激素释放激素(GHRH)+精氨酸试验,GH-RH+生长激素释放肽(GHRP)及胰高血糖素兴奋试验的诊断价值与ITT相当。成人GHD常合并多种并发症,其中慢性心血管系统并发症可能是导致该类患者病死率增加的主要原因。而重组人生长激素(rh-GH)替代治疗可以改善这部分患者的许多临床终点事件,包括生活质量的提高及心血管风险的降低等。Adult growth hormone deficiency （GHD） , mainly defined by a series of nonspeeific clinical manifestations and relevant hiomarkers,is well-reeognized as structural or functional damage in hypothalamus and/or pituitary gland. Due to pulsatile secretion of growth hormone （GH） and variations among random population, differentiation of patients with GHD and normal individuals should not be made simply depending on the level of GH. The well-acknowledged insulin tolerance test （ITT） remains the gold standard for diagnosis of GHD in adults,and it is not until recently when the combination of growth hormone releasing hormone （GHRH） and arginine test as well as the combination of GHRH with growth hormone releasing peptide （GHRP） and glucagon stimulating test are considered to share similar diagnostic value with ITT. Multiple complications are common in adults with GHD, among which chronic cardiovascular complications might be the chief cause for increased mortality rate. Recombinant human growth hormone （rhGH） replacement therapy could improve most of the clinical endpoint events, including elevation of quality of life and reduction in the risk of cardiovascular events.

关 键 词：成人生长激素缺乏症 指南解读 

分 类 号：R584.2[医药卫生—内分泌]