重組人生長激素治療特發性身材矮小癥療效的系統評價_《中國循證醫學雜志》

作者：

高嵐 ¹ , 徐婧 ² , 楊凡 ³ ,  康德英 ⁴

1. 中醫中醫科學院廣安門醫院（北京 100053）；2. 四川省成都市新津縣婦幼保健院（成都 611430）；3. 四川大學華西婦產兒童醫院（成都 610041）；4. 四川大學華西醫院中國循證醫學中心（成都 610041）;

關鍵詞：

重組人生長激素特發性身材矮小癥系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20120233

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目的　系統評價重組人生長激素（rhGH）治療特發性身材矮小癥的長期效果。
方法　計算機檢索PubMed、ScienceDirect、EBSCOHost、EMbase、The Cochrane Library、CBM、CNKI和VIP數據庫，檢索時限為1985～2010年，搜集rhGH治療特發性身材矮小癥的隨機對照試驗（RCT）。按照Cochrane系統評價方法，由2名評價員獨立進行文獻篩選、資料提取和納入研究的方法學質量評估后，采用RevMan 5.0軟件進行Meta分析。
結果　最終納入11個RCT，共607例特發性身材矮小癥兒童。Meta分析結果顯示：治療1年后，rhGH組身高標準差積分（SDS）明顯高于空白/安慰劑對照組［MD=0.29 SDS，95%CI（0.03，0.54），P=0.03］，rhGH組身高增長速度（GV）明顯高于空白/安慰劑對照組［MD= 2.68 cm/年，95%CI（1.70，3.65），P lt;0.000 01］，rhGH組成年SDS明顯高于空白/ 安慰劑對照組［MD=0.46 SDS，95%CI（0.29，0.63），P lt;0.000 01］。
結論　rhGH可有效促進特發性身材矮小兒童的生長。但由于納入研究質量不高，樣本量較少，其效果尚需更多高質量RCT進一步驗證。

引用本文： 高嵐,徐婧,楊凡,康德英. 重組人生長激素治療特發性身材矮小癥療效的系統評價. 中國循證醫學雜志, 2012, 12(12): 1516-1521. doi: 10.7507/1672-2531.20120233 復制

1.	劉戈力. 特發性身材矮小. 中國實用兒科雜志, 2005, 20(8): 453-455.
2.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version5.1.2[updated March 2011], The Cochrane Collaboration, 2011. [2011-06-10] Available from: http://www.cochrane-handbook.org.
3.	Abrams KR, Gillies CL, Lambert PC. Meta-analysis of heterogeneously reported trials assessing change from baseline. Statistics in Medicine, 2005, 24(24): 3823-3844.
4.	Leschek EW, Rose SR, Yanovski JA, et al. Effect of growth hormone treatment on adult height in peripubertal children with idiopathic short stature: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab, 2004, 89(7): 3140-3148.
5.	van Gool SA, Kamp GA, Odink RJ, et al. High-dose GH treatment limited to the prepubertal period in young children with idiopathic short stature does not increase adult height. Eur J Endocrinol, 2010, 162(4): 653-660.
6.	Soliman AT, Khadir MMA. Growth parameters and predictors of growth in short children with and without growth hormone (GH) deficiency treated with human GH: a randomized controlled study. J Trop Pediatr, 1996, 42(5): 281-286.
7.	Coutant R, Rouleau S, Despert F, et al. Growth and adult height in GH-treated children with nonacquired GH deficiency and idiopathic short stature: the influence of pituitary magnetic resonance imaging findings. J Clin Endocrinol Metab, 2001, 86(10): 4649-4654.
8.	Zadik Z, Mira U, Landau H. Final height after growth hormone therapy in peripubertal boys with a subnormal integrated concentration of growth hormone. Horm Res, 1992, 37(4-5): 150-155.
9.	Wit JM, Boersma B, de Muinck Keizer-Schrama SM, et al. Long-term results of growth hormone therapy in children with short stature, subnormal growth rate and normal growth hormone response to secretagogues. Dutch Growth Hormone Working Group. Clin Endocrinol (Oxf), 1995, 42(4): 365-372.
10.	Buchlis JG, Irizarry L, Crotzer BC, et al. Comparison of final heights of growth hormone-treated vs. untreated children with idiopathic growth failure. J Clin Endocrinol Metab, 1998, 83(4): 1075-1079.
11.	van Gool SA, Kamp GA, Visser-van Balen H, et al. Final height outcome after three years of growth hormone and gonadotropin-releasing hormone agonist treatment in short adolescents with relatively early puberty. J Clin Endocrinol Metab, 2007, 92(4): 1402-1408.
12.	Genentech Collaborative Study Group. Idiopathic short stature: results of a one-year controlled study of human growth hormone treatment. J Pediatr, 1989, 115(5 Pt 1): 713-719.
13.	Rekers-Mombarg LT, Kamp GA, Massa GG, et al. Influence of growth hormone treatment on pubertal timing and pubertal growth in children with idiopathic short stature. Dutch Growth Hormone Working Group. J Pediatr Endocrinol Metab, 1999, 12(5): 611-622.
14.	Kamp GA, Waelkens JJ, de Muinck Keizer-Schrama SM, et al. High dose growth hormone treatment induces acceleration of skeletal maturation and an earlier onset of puberty in children with idiopathic short stature. Arch Dis Child, 2002, 87(3): 215-220.
15.	馬祖祥, 易著文, 吳小川, 等. 環磷酰胺在難治性腎病綜合征治療中的應用——30年文獻Meta 分析. 中華兒科雜志, 2002, 40(345): 342-435.

1. 劉戈力. 特發性身材矮小. 中國實用兒科雜志, 2005, 20(8): 453-455.
2. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version5.1.2[updated March 2011], The Cochrane Collaboration, 2011. [2011-06-10] Available from: http://www.cochrane-handbook.org.
3. Abrams KR, Gillies CL, Lambert PC. Meta-analysis of heterogeneously reported trials assessing change from baseline. Statistics in Medicine, 2005, 24(24): 3823-3844.
4. Leschek EW, Rose SR, Yanovski JA, et al. Effect of growth hormone treatment on adult height in peripubertal children with idiopathic short stature: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab, 2004, 89(7): 3140-3148.
5. van Gool SA, Kamp GA, Odink RJ, et al. High-dose GH treatment limited to the prepubertal period in young children with idiopathic short stature does not increase adult height. Eur J Endocrinol, 2010, 162(4): 653-660.
6. Soliman AT, Khadir MMA. Growth parameters and predictors of growth in short children with and without growth hormone (GH) deficiency treated with human GH: a randomized controlled study. J Trop Pediatr, 1996, 42(5): 281-286.
7. Coutant R, Rouleau S, Despert F, et al. Growth and adult height in GH-treated children with nonacquired GH deficiency and idiopathic short stature: the influence of pituitary magnetic resonance imaging findings. J Clin Endocrinol Metab, 2001, 86(10): 4649-4654.
8. Zadik Z, Mira U, Landau H. Final height after growth hormone therapy in peripubertal boys with a subnormal integrated concentration of growth hormone. Horm Res, 1992, 37(4-5): 150-155.
9. Wit JM, Boersma B, de Muinck Keizer-Schrama SM, et al. Long-term results of growth hormone therapy in children with short stature, subnormal growth rate and normal growth hormone response to secretagogues. Dutch Growth Hormone Working Group. Clin Endocrinol (Oxf), 1995, 42(4): 365-372.
10. Buchlis JG, Irizarry L, Crotzer BC, et al. Comparison of final heights of growth hormone-treated vs. untreated children with idiopathic growth failure. J Clin Endocrinol Metab, 1998, 83(4): 1075-1079.
11. van Gool SA, Kamp GA, Visser-van Balen H, et al. Final height outcome after three years of growth hormone and gonadotropin-releasing hormone agonist treatment in short adolescents with relatively early puberty. J Clin Endocrinol Metab, 2007, 92(4): 1402-1408.
12. Genentech Collaborative Study Group. Idiopathic short stature: results of a one-year controlled study of human growth hormone treatment. J Pediatr, 1989, 115(5 Pt 1): 713-719.
13. Rekers-Mombarg LT, Kamp GA, Massa GG, et al. Influence of growth hormone treatment on pubertal timing and pubertal growth in children with idiopathic short stature. Dutch Growth Hormone Working Group. J Pediatr Endocrinol Metab, 1999, 12(5): 611-622.
14. Kamp GA, Waelkens JJ, de Muinck Keizer-Schrama SM, et al. High dose growth hormone treatment induces acceleration of skeletal maturation and an earlier onset of puberty in children with idiopathic short stature. Arch Dis Child, 2002, 87(3): 215-220.
15. 馬祖祥, 易著文, 吳小川, 等. 環磷酰胺在難治性腎病綜合征治療中的應用——30年文獻Meta 分析. 中華兒科雜志, 2002, 40(345): 342-435.

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重組人生長激素治療特發性身材矮小癥療效的系統評價

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《中國循證醫學雜志》

重組人生長激素治療特發性身材矮小癥療效的系統評價

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