Effects And Influencing Factors Of Therapy With RhGH On Linear Growth In Children With Short Stature And The Establishment Of Prediction Model

Objectives To analyze the effect of recombinant human growth hormone(rhGH)which is used to improve the height of pediatric patients;To investigate the various factors of influcing the therapy of rhGH as to identify the value of rhGH early;To develop prediction models of the therapy of rhGH.It provides the basis for finding a cost-effective therapeutic approach.Methods One hundred and sixty pediatric patients with growth hormone deficiency(GHD)and idiopathic short stature(ISS)were enrolled,who have been explicitly diagnosed and regularly treated at least 6 months from April 2016 to October 2017 at specialty clinic for growth and develop in Tangshan Maternity and Child Health Care Hospital.Among them,99 patients with GHD(52 boys and 47 girls)and 61 with ISS(30boys and 31 girls).A retrospective analysis according to their clinical data was performed.All the detailed medical history of patients were collected,including physical examination,laboratory and imaging examination at initial,3 and 6 month treatment.The height was measured by the same professional person per three month.The height standard deviation score(HtSDS)and height velocity(HV)were calculated.Bone age were measured every six month.Statistical analyses were performed using SPSS22.0.The height and HtSDS of GHD and ISS patients were analyzed by repeated measure anova.The paired t-test was used to compare the change of height,HtSDS and HV.The relationship between auxological measures and biochemical indicators were measured at base line and 6 months delta in height SDS[ΔHtSDS(+6)]or height velocity[HV(+6)]were analyzed by Pearson’s correlation.Based on the result of Pearson’s correlation analysis,we established prediction models on therapy effect in first six months by multiple linear regression.Results 1 In GHD group,the height was(116.03±13.74)cm,(119.19±13.65)cm and(122.14±13.65)cm at initial treatment,3-month treatment and 6-month treatment.The HtSDS was(-2.69±0.68),(-2.27±0.77)and(-2.03±0.68)at initial treatment,3-month treatment and 6-month treatment.After 3 or 6 month treatment of GHD grpup,the height and HtSDS were increased,the differences showed statistically significant(P<0.05).In ISS group,the height was(122.99±14.96)cm,(125.62±14.89)cm and(128.21±14.91)cm at initial treatment,3-month treatment and 6-month treatment.The HtSDS was(-2.43±0.48)、(-2.22±0.50)、(-2.11±0.53).After 3 or 6 month treatment of ISS grpup,the height and HtSDS were increased,the differences showed statistically significant(P<0.05).2 After 3 or 6 months treatment with rhGH in GHD,HV was(12.62±2.50)cm/yr vs.(11.82±2.07)cm/yr,ΔHtSDS was(0.42±0.38)vs.(0.24±0.31)andΔHt was(3.16±0.62)cm vs.(2.95±0.52)cm.The HV,ΔHtSDS andΔHt during the first 3month were all larger than those in 3~6 month.The differences all showed statistically significant(P<0.05).After 3 or 6 months treatment with rhGH in ISS,HV was(10.54±1.21)cm/yr vs.(10.33±1.20)cm/yr,ΔHtSDS was(0.22±0.26)vs.(0.11±0.27)andΔHt was(2.64±0.30)cm vs.(2.58±0.30)cm.The HV,ΔHtSDS andΔHt during the first 3month were all larger than those in 3~6 month.HV andΔHt showed statistically significance(P<0.05).3 In GHD group,the parameters such as height(0),HtSDS(0),HV(+3)are positively associated withΔHtSDS(+3);the parameters such as age and BA/CA have negative correlation with HV(+3);MPH,BA and CA-BA are positively associated with HV(+3);In ISS group,HtSDS(0)are positively associated withΔHtSDS(+3);the parameters such as age,BA and lg[max-GH(ng/mL)]have negative correlation withΔHtSDS(+3);BA and BA/CA are negatively associated with HV(+3);CA-BA are positively associated with HV(+3)。4 In GHD group,the parameters such as BA/CA have negative correlation withΔHtSDS(+6);Height(0),HtSDS(0),MPH,CA-BA,HV(+3)are positively associated withΔHtSDS(+6);BA and BA/CA have negative correlation with HV(+6);MPH,CA-BA and HV(+3)were positively associated with HV(+6).In ISS group,CA-BA and HV(+3)were positively associated withΔHtSDS(+6);Only BA/CA have negative relationships withΔHtSDS(+6).CA-BA,BA/CA and HV(+3)were positively associated with HV(+6).5 The prediction model developing by multiple regression analysis as following equation:ΔHtSDS(+6)=-0.744+0.066×HV(+3)-0.497×BA/CA-0.066×Ht SDS(0)+0.004×MPH,the R~2 value was 0.908.The prediction model of ISS group has not developed succeed.Conclusions Significant effect was obtained in the first 3 months start the treatment.The study succeeding in developing prediction models.It has been got that there have positive correlations betweenΔHtSDS(+6)and MPH,HV(+3),BA/CA and HtSDS(0)were negatively related to it.