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장기간의 스테로이드 치료를 받고 있는 신병증 환아에서 Recombinant Human Growth Hormone의 효과

The Effect of Recombinant Human Growth Hormone on Growth in Children with Nephropathy Receiving Long-term Steroid Therapy

김선경|김성도|조병수|김세진
대한소아신장학회 (The Korean Society Of Pediatric Nephrology)|2006.09|Childhood Kidney Diseases (Childhood Kidney diseases)|제10권 제2호|pp. 141-150

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주제분류소아과학

초록

목 적 : 성장 저하는 장기간 스테로이드 치료를 받고 있는 신 질환 환아에서 보이는 심각한 문제 가운데 하나이다. 본 저자들은 이들 환아에게 투여된 rhGH의 효과와 안정성을 알아보고자 본 연구를 계획하였다. 방 법 : 총 60명(남아 47, 여아 13)의 신 질환 환아들을 대상으로 rhGH(1 IU/kg/wk)을 1.39±1.12년간 투여하였고 환아들의 평균 나이는 11.17±2.62세였다. 환아들은 장기간 스테로이드 치료를 받고 있는 상태로 평균 스테로이드 투여 기간은 4.32±2.97년이었다. 신증후군 환아들이 32명으로 가장 많았고, IgA 신병증이 9명, 메산지움 증식성 사구체 신염이 4명의 순이었다. rhGH 투여를 전후로 성장 속도, 신장 SDS 등의 성장 지표를 구하였고 BMD 검사와 IGF-1, IGFBP-3, 일반 화학 검사들을 시행하였다. 결 과 : rhGH투여 후 성장 속도는 3.29±1.95 cm/yr에서 8.66±3.75 cm/yr으로 증가였고 신장 SDS는 rhGH 투여 전 1년간 -0.72±0.93에서 -1.04±0.86으로 악화되는 모습 보이다가 투여 시작 1년후 -0.55±0.96으로 통계적으로 의미 있게 증가되는 양상을 보였다(P<0.05). BMD는 0.71±0.14 g/cm2에서 0.79±0.16 g/cm2으로 증가하였다(P<0.05). IGF-1은 의미 있는 증가(445.09±138.01 to 506.62±181.31 ng/mL) (P<0.05)를 보였으나 IGFBP-3는 큰 차이가 없었다(4073.75±700.78 to 3933.61±789.25 ug/L, P=0.533). 결 론 : 장기간 스테로이드 치료를 받고 있는 신 질환 환아에서 rhGH의 투여는 특별한 부작용 없이 성장 속도, 신장 SDS, BMD 등의 성장 지표에 호전을 보였고 추후 보다 장기적인 rhGH의 효과와 안정성에 대한 연구가 필요할 것으로 생각된다.

Abstract

Purpose : Growth retardation is one of the serious problems in children with nephropathy requiring long-term steroid therapy. We observed the efficacy and safety of recombinant human growth hormone(rhGH) on the growth in children with long-term steroid therapy. Methods : We studied 60 children(male 47, female 13) with nephropathy who received rhGH (1 U/kg/week) for more than 0.5 years(1.39±1.12). Their mean age was 11.0 years (11.17±2.62). They received steroid therapy from January 1987 through July 2005, and the mean duration of steroid therapy was 4.32±2.97 years. Among the patients, there were 32 nephrotic syndrome, 9 IgA nephropathy, 4 mesangial proliferative glomerulonephritis, 4 focal segmental glomerulosclerosis, 2 Henoch Sch&ouml;nlein nephritis, 2 Alport syndrome and 7 other cases. Data were gathered on the growth parameters, such as growth velocity, height standard deviation score(SDS), IGF-1, IGFBP-3, bone mass density(BMD) and general chemistry changes. Results : Height velocity increased significantly with rhGH therapy from 3.29±1.95 to 8.66±3.75(cm/yr) and height SDS decreased from -0.72±0.93 to -1.04±0.86 at one year after steroid therapy but increased to -0.55±0.96 at one year after rhGH administration(P<0.05). BMD improved from 0.71±0.14 to 0.79±0.15 g/cm2(P<0.05). IGF-1 increased from 445.09±138.01 to 506.62±181.31 ng/mL(P<0.05). IGFBP-3 decreased from 4073.75±700.78 to 3933.61±789.25 ug/L numerically, but there was no statistically significant difference(P=0.533). Conclusion: The administration of rhGH in the short stature patients who received long-term steroid therapy showed improvement in growth parameters such as SDS, growth velocity, and BMD without significant side-effects or changes in the biochemical parameters.

참고문헌 (39)

  1. Mehls O, "Interaction between glucocorticoids and growth hormone", 388, pp.77~82 (1993)
  2. Martul P, "Corticoid-induced growth-hormone(GH)secretion in GH-deficient and normal children", 75, pp.536~9 (1992)
  3. Giustina A, "The role of glucocorticoids in the regulation of growth hormone secretion-mechanisms and clinical significance", 3, pp.306~11 (1992)
  4. Weinstein RS, "Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone", 102, pp.274~282 (1998)
  5. Hofbauer LC, "Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic lineage cells:potential paracrine mechanisms of glucocorticoid-induced osteoporosis", 140, pp.4382~4389 (1999)
  6. Silberman M, "Mechanism of glucocorticoid induced growth retardation:impairment of cartilage mineralization", 101, pp.140~9 (1978)
  7. Hahn TJ, "Altered mineral metabolism in glucocorticoid-induced osteopenia", 64, pp.655~65 (1979)
  8. Zhou X, "IGFs and IGF-binding proteins in short children with steroid-dependent nephrotic syndrome on chronic glucocorticoids:changes with 1 year exogenous GH", 144, pp.237~243 (2001)
  9. Loke KY, "Efficacy and safety of one year of growth hormone therapy in steroid- dependent nephrotic syndrome", 130, pp.793~799 (1997)
  10. Allen DB, "Treatment of glucocorticoid-induced growth suppression with growth hormone. On behalf of the National Cooperative Growth Study", 83, pp.2824~2829 (1998)
  11. Bar-On E, "Effect of chemotherapy on human growth plate", 13, pp.220~4 (1993)
  12. Baron J, "Dexamethasone acts locally to inhibit longitudinal bone growth in rabbits", 263, pp.~92 (1992)
  13. Kamischke A, "Testosterone levels in men with chronic obstructive pulmonary disease with or without glucocorticoid therapy", 11, pp.41~45 (1998)
  14. Sakakura M, "Inhibition of luteinizing hormone secretion induced by synthetic LRH by long-term treatment with glucocorticoids in human subjects", 40, pp.774~9 (1975)
  15. Crilly R, "Hormonal status in normal,osteoporotic and corticosteroid-treated postmenopausal women", 71, pp.733~6 (1978)
  16. Touati G, "Beneficial effects of one- year growth hormone administration to children with juvenile chronic arthritis on chronic steroid therapy,I:effects on growth velocity and body composition", 83, pp.403~409 (1998)
  17. Tonshoff B, "Effects of two years of growth hormone treatment in short children with renal disease", 379, pp.33~41
  18. Yang SW, "The effect of recombinant human growth hormone on the growth in the children with chronic renal failure", 39, pp.997~1004 (1996)
  19. Koh SW, "Short term effect of recombinant human growth hormone therapy in children with chronic renal failure", 41, pp.1256~1261 (1998)
  20. Chesney RW, "Reduction of serum-1", pp.25 1123~5, in children receiving glucocorticosteroids
  21. Lettgen B, "Influence of steroid medication on bone mineral density in children with nephrotic syndrome", 8, pp.667~70 (1994)
  22. Chesney RW, "Effect of prednisone on growth and bone mineral content in childhood glomerular disease", 132, pp.768~72 (1978)
  23. Steendijk R, "Remarkable catch-up growth in a boy with steroid- responsive nephrotic syndrome", 279, pp.8~12 (1986)
  24. Gibson AT, "Growth retardation after dexamethasone administration", 69, pp.505~9 (1993)
  25. Haffner D, "Predictors of growth response to rhGH in short children before and after renal transplantation German Study Group for Growth Hormone Treatment in Chronic Renal Failure", pp.~82
  26. Crofton PM, "Effects of intensive chemotherapy on bone and collagen turnover and the growth hormone axis in children with acute lymphoblastic leukemia", 83, pp.3121~3129 (1998)
  27. Ahmed SF, "Short-term changes in lower leg length in children treated for acute lymphoblastic leukaemia", 12, pp.75~80 (1999)
  28. Blodget FM, "Effects of prolonged cortisone therapy on the statural growth,skeletal maturation and metabolic status of children", 254, pp.636~41 (1956)
  29. Avioli LV, "Glucocorticoid effects on statural growth", 32(2), pp.27~30 (1993)
  30. Rivkees SA, "Prednisolone dose limitation of growth hormone treatment of steroid-induced growth failure", 125, pp.322~5 (1994)
  31. Binz K, "Interactions of insulin-like growth factor I with dexamethasone on trabecular bone density and mineral metabolism in rats", 130, pp.387~93 (1994)
  32. Lee DY, "Insulin-like growth factor-I(IGF-I)and IGF-binding proteins in children with nephrotic syndrome", 81, pp.1856~1860 (1996)
  33. Haffner D, "Insulin-like growth factors(IGFs) and IGF binding, proteins serum acid-labile subunit and growth hormone binding protein in nephrotic children", 52, pp.802~810 (1997)
  34. Blum WF, "Levels of growth hormone and cortisol in prednisolone-treated children with growth retardation after renal transplantation", pp.932~8, de Muinck Keizer-Schrama SM
  35. Maxwell H, "Recombinant human growth hormone treratment in infants with chronic renal failure", 74, pp.40~43 (1996)
  36. Mehls O, "Growth response to recombinant human growth hormone in short prepubertal children with chronic renal failure with or without dialysis", 399, pp.81~7 (1994)
  37. Heather M, "Differential effects of recombinant human growth hormone on glomerular filtration rate and renal plasma flow in chronic renal failure", 9, pp.458~463 (1995)
  38. Olefsky JM, "Effect of glucocorticoids on carbohydrate metabolism", 271, pp.202~10 (1976)
  39. Czernikow P, "Growth hormone administration and carbohydrate metabolism", 39, pp.102~3 (1993)

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