重组人生长激素(recombinant human growth hormone,rhGH)于1985年上市,已广泛应用于身材矮小的患儿,其治疗有效性得到广泛临床验证。生长激素除具有促线性增长作用外,还具有改善身体组分及代谢、增加骨密度、提高生活质量等作用,因而被应用于成人生长激素缺乏症患者。但生长激素的临床应用具有较强的专业性,需严格掌握适应证、治疗及安全监测,以保证药物的合理、有效、安全应用。笔者参照2000—2012年美国食品和药品管理局(FDA)、欧洲药品管理局(EMEA)、美国LawsonWilkins儿科内分泌学会、欧洲儿科内分泌学会(ESPE)、生长激素研究学会(GHRS)及美国临床内分泌学会(AACE)制定的多项临床指南或专家共识,并参照2013年中华医学会儿科学分会制定的《基因重组人生长激素儿科临床规范应用的建议》,对生长激素在内分泌疾病中应用的热点问题进行阐述和补充。
[1]中华医学会儿科学分会内分泌遗传代谢学组,《中华儿科杂志》编辑委员会.基因重组人生长激素儿科临床规范应用的建议[J].中华儿科杂志,2013,51(6):426-432.
[2]Wilson TA1,Rose SR,Cohen P,et al.Update of guidelines for the use of growth hormone in children:the Lawson Wilkins Pediatric Endocrinology Society Drug and Therapeutics Committee[J].J Pediatr,2003,143(4):415-421.
[3]中华医学会儿科学分会内分泌遗传代谢学组.矮身材儿童诊治指南[J].中华儿科杂志,2008,46(6):428-430.
[4]Growth Hormone Research Society.Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence:summary statement of the GH Research Society.GH Research Society[J].J Clin Endocrinol Metab,2000,85(11):3990-3993.
[5]Gharib H,Cook DM,Saenger PH,et al.American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children-2003 update[J].Endocr Pract,2003,9(1):64-76.
[6]Cohen P,Rogol AD,Deal CL,et al.Consensus statement on the diagnosis and treatment of children with idiopathic short stature:a summary of the Growth Hormone Research Society,the Lawson Wilkins Pediatric Endocrine Society,and the European Society for Paediatric Endocrinology Workshop[J].J Clin Endocrinol Metab,2008,93(11):4210-4217.
[7]Clayton PE,Cianfarani S,Czernichow P,et al.Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society[J].J Clin Endocrinol Metab,2007,92(3):804-810.
[8]Deal CL,Tony M,Hybye C,et al.GrowthHormone Research Society workshop summary:consensus guidelines for recombinant human growth hormone therapy in PraderWilli syndrome[J].J Clin Endocrinol Metab,2013,98(6):1072-1087.
[9]Saenger P,Wikland KA,Conway GS,et al.Recommendations for the diagnosis and management of Turner syndrome[J].J Clin Endocrinol Metab,2001,86(7):3061-3069.
[10]Inzaghi E,Cianfarani S.The challenge of growth hormone deficiency diagnosis and treatment during the transition from puberty into adulthood[J].Front Endocrinol (Lausanne),2013,20(4):34.
[11]Cook DM,Yuen KC,Biller BM,et al.American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in growth hormonedeficient adults and transition patients2009 update:executive summary of recommendations[J].Endocr Pract,2009,15(6):580-586.
[12]Ho KK,GH Deficiency Consensus Workshop Participants.Consensus guidelines for the diagnosis and treatment of adults with GH deficiency Ⅱ:a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology,Lawson Wilkins Society,European Society of Endocrinology,Japan Endocrine Society,and Endocrine Society of Australia[J].Eur J Endocrinol,2007,157(6):695-700.
[13]Molitch ME,Clemmons DR,Malozowski S,et al.Evaluation and treatment of adult growth hormone deficiency:an Endocrine Society clinical practice guideline[J].J Clin Endocrinol Metab,2011,96(6):1587-1609.
[14]Clayton PE,Cuneo RC,Juul A,et al.Consensus statement on the management of the GHtreated adolescent in the transition to adult care[J].Eur J Endocrinol,2005,152(2):165-170.
[15]Bell J,Parker KL,Swinford RD,et al.Longterm safety of recombinant human growth hormone in children[J].J Clin Endocrinol Metab,2010,95(1):167-177.
[16]Bell J,Parker KL,Swinford RD,et al.Recurrence of brain tumours in patients treated with growth hormone:analysis of KIGS (Pfizer International Growth Database)[J].Acta Paediatr,2006,95(10):1284-1290.
[17]Swerdlow AJ,Higgins CD,Adlard P,et al.Risk of cancer in patients treated with human pituitary growth hormone in the UK,195985:a cohort study[J].Lancet,2002,360(9329):273-277.