Objective To observe the therapeutic effect of vitamin D combined with recombinant human growth hormone (r-hGH) for children with idiopathic dwarf syndrome (ISS).
Methods A total of 92 children with ISS admitted to our hospital from July 2018 to May 2020 were divided into two groups according to a random number table method. Among them, 46 patients who were treated with r-hGH were set as control group, and 46 patients who received oral vitamin D drops on the basis of the control group were set as treatment group. In addition, 45 healthy children in the same period were selected as normal group. The growth and development indexes height, body mass, bone age, growth rate, and height standard deviation score (HtSDS) of the treatment and control groups before treatment and 1 year after treatment and the normal group at physical examination were measured. Serum levels of 25 hydroxyvitamin D25(OH)D, growth hormone releasing peptide (Ghrelin), and growth factorsinsulin-like growth factor-1 (IGF-1), insulin-like growth factor-binding protein-3 (IGFBP-3)in the control group and the treatment group were detected. The total incidence of adverse reactions in the two groups was recorded.
Results The values of body mass, height, growth rate, bone age and HtSDS in the normal group at physical examination were higher than those in the treatment group and control group before treatment, and the difference was statistically significant (P < 0.05). There was no significant difference in the above growth and development indexes between treatment group and control group before treatment (P>0.05). After 1 year of treatment, height, body weight, growth rate, bone age and HtSDS of children in the treatment group and control group were all higher than before, and other growth and development indicators except bone age in the treatment group were better than those in the control group after 1 year of treatment, the differences were statistically significant (P < 0.05). The serum 25(OH)D level in the normal group was higher at physical examination than that in the treatment group and control group before treatment, and the serum Ghrelin level was lower than that in the treatment group and control group before treatment, and the difference was statistically significant (P < 0.05). There were no significant differences in serum 25(OH)D and Ghrelin levels between treatment group and control group before treatment (P>0.05); after 1 year of treatment, serum 25(OH)D level in two groups was higher than before treatment, serum Ghrelin level was lower than before treatment, and serum 25(OH)D level in the treatment group was higher than that of the control group, serum Ghrelin level was lower than that in the control group, the differences were statistically significant (P < 0.05). The levels of serum IGF-1 and IGFBP-3 in the normal group at physical examination were higher than those in the treatment group and the control group before treatment (P < 0.05). There were no significant differences in serum IGF-1 and IGFBP-3 levels before treatment between treatment group and control group (P>0.05). After 1 year of treatment, the above growth factor levels in the treatment group and the control group were higher than before treatment, and were higher in the treatment group than those in the control group (P < 0.05). The incidence of adverse drug reactions in the treatment group was 8.70%, which showed no statistically significant difference compared with 13.04% in the control group (P>0.05).
Conclusion The growth and development of children with ISS are abnormal, and their serum expression of 25(OH)D, IGF-1 and IGFBP-3 are low and expression of serum Ghrelin is high. However, the treatment of vitamin D combined with r-hGH can significantly increase serum 25(OH)D and growth factor levels, significantly reduce Ghrelin level, effectively promote growth and development, and has higher safety.
DownLoad: