Changes And Analysis Of Serum IGF-1,25(OH)D Before And After RhGH Treatment In GHD Children

Objective: Growth hormone deficiency(GHD)is a growth disorder disease due to the anterior pituitary synthesis and secretion growth hormone(GH)partial or completely deficiency,or due to the GH molecular structure and receptor abnormity,which is one of the main etiologies of the children with short statures.At present,the diagnosis of GHD is mainly through the growth hormone stimulation tests,but many factors can affect the outcomes and prone to error easily,so it does not reflect the physiological condition of the GH.While he levels of IGF-1 and GH roughly parallel within 24 hours,no obvious way of pulse secretion and the change of circadian rhythm,so we could measure the levels of IGF-1 to indirectly reflect the stature of endogenous GH,used for monitoring and clinical diagnosis of GHD.The basic of the increased of height is bone growth,and vitamin D can promote the proliferation of bone cells and the formation of the bone matrix,which plays a key roe in bone growth and development.As of date,few and conflicting studies have prospectively analyzed vitamin D before and after rhGH treatment.The purpose this study was to observe the changes of IGF-1,25(OH)D before and after 3 months of rhGH treatment and the krelationship of them in GHD children,explore the influence of rhGH on IGF-1 and 25(OH)D,providing more favorable basis for clinic diagnosis and treatment of GHD children.Methods: Based on physical development survey data in 9 province/cities in the year 2005 as the parameters of height standard,selected 31 cases which diagnosed GHD and accepted 3 months of rhGH therapy in pediatric clinic of the third hospital of Hebei medical university from January 2015 to August 2015 as the experiment group,age(3.5-15years),average age(9.08 ± 3.55 years),including male 20 and female 11,and randomly selected 20 cases of healthy children as the normal control group.Short stature diagnostic criteria in according to the Chinese medical association academy of pediatric genetic metabolic endocrine group《The diagnosis and treatment guide of short stature children》,living in similar environment,the same race,gender and age individuals height is lower than the general population average height 2 standard deviation or below the third percentile specimen.The morning fasting venous blood were obtained from experimental group children before and after rhGH therapy,after standing and centrifugation,put these serum on-80℃ low temperature refrigerator for the detection of serum IGF-1and 25(OH)D levels,and took fully physical examination and information record on them.Each of the control group children were took fasting venous blood 2ml to detect the levels of IGF-1.This study used chemiluminescence to detect serum IGF-1 values.Serum 25(OH)D values were obtained by Hai SI Te inspection center using high performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS).All data were tested for normality and homogeneity of variance.Normal distribution measurement data were presented as mean ± standard deviation(x ±s).Difference between two group were analyzed by independent-sample T test,the paired-samples T test used to compare date before and after treatment.The relevancy between variables were analyzed by Pearson correlation analysis.Differences was considered as significance at P<0.05.Results:(1)After 3 months of rhGH treatment,the growth velocity of GHD children was significantly accelerated(4.00±0.56cm/year vs.11.52±0.56cm/year before and after treatment,P=0.000<0.05);Body mass index(BMI)without significant change(16.06±2.05 vs.15.89±1.65 before and after treatment,P=0.896>0.05);(2)The serum level of IGF-1 were significantly lower in GHD group than control group(149.01±71.20ng/ml vs.448.21 士 149.73ng/ml,P=0.000<0.05),after 3 moths of rhGH treatment,the levels of IGF-1 increased significantly in GHD children(149.01±71.20ng/ml vs.220±95.16ng/ml,P=0.000<0.05);(3)After 3 moths of rhGH treatment,the levels of 25(OH)D increased significantly in GHD children(19.56±14.95ng/ml vs.26.17±13.77ng/ml P=0.000<0.05);(4)There was a very high prevalence of hypovitaminosis D in GHD children,before rhGH treatment,the level of 25(OH)D sufficient accounting for 19.35%,insufficient accounting for 9.68% and deficiency accounting for 71.97%;After rhGH treatment,the level of 25(OH)D sufficient accounting for 29.03%,insufficient accounting for 29.03% and deficiency accounting for 41.94%;(5)There was correlation between the concentrations of serum 25(OH)D and Ca,BMI in GHD children(r=0.431,P=0.015 and r=-0.421,P=0.018);there was no correlation between the concentrations of serum 25(OH)D and P,ALP in GHD children(r=0.83,P=0.324 and r=-0.293,P=0.11);(6)There was no correlation between 25(OH)D and IGF-1 in GHD children before and after rhGH treatment(r=-0.345,P=0.058 and r=-0.313,P=0.087).Conclusions:1 RhGH replacement therapy has significant effect on GHD children,it can improve the growth velocity but no impact on BMI.2 There is a high prevalence of vitamin D deficiency or insufficient in GHD children,maybe one of the reasons leading to the growth obstacles in GHD children.Though the levels of 25(OH)D in GHD children increased after rhGH replacement therapy,but it does not achieve to the normal level through the short-term treatment.So it is recommended that vitamin D should supplement during the rhGH replacement therapy and vitamin D assessment should therefore be considered routinely in GHD children both at diagnosis and during the follow-up.3 The levels of IGF-1 increased significantly after 3months of rhGH replacement therapy,so we should monitor the levels of IGF-1 regularly,according to it adjust the rhGH dosage to achieve the best effect and avoid side-effects.4 There is no correlation between 25(OH)D and IGF-1 in GHD children before and after rhGH treatment.