| 摘要: |
| 目的:探讨磁共振成像(MRI)测量的垂体高度在儿童生长激素缺乏症(GHD)与特发性矮身材(ISS) 的鉴别诊断中的价
值及其对重组人生长激素(rhGH)治疗反应的预测意义。方法:回顾性收集香港大学深圳医院2020 年6 月至2023 年6 月初诊
的矮身材患儿,初筛106 例,最终纳入75 例(GHD 48 例、ISS 27 例),完善GH 激发试验、3. 0T 垂体MRI、胰岛素生长因子-1(IGF-1)
检测并规范rhGH 治疗随访12 个月。比较基线资料、垂体高度标准差分值(SDS)、GH 峰值、年生长速率变化(ΔGV)、身高标准
差分值变化(ΔHt SDS),采用Pearson 相关分析、单因素及多元线性回归分析疗效影响因素。结果:GHD 组垂体高度SDS 低于
ISS 组(P =0. 063);ISS 组垂体高度变异范围大,提示病因异质性显著。GHD 组GH 激发试验峰值低于ISS 组(P<0. 001)。治疗
12 个月后,GHD 组ΔGV、ΔHt SDS 优于ISS 组(均P<0. 05)。Pearson 相关分析提示GHD 组垂体高度SDS 与ΔHt SDS 呈弱负相
关(r =-0. 31,P =0. 034),ISS 组二者无显著相关性(r =-0. 26,P =0. 180)。单因素分析提示GHD 早期治疗年龄与疗效相关,但
多因素校正后仅ΔGV 为疗效独立影响因素(P =0. 013);ISS 各基线指标均无法独立预测疗效。结论:垂体高度对GHD 诊断具有
一定的辅助诊断价值,但无法明确GHD 病情严重程度,诊断需结合GH、IGF-1 等功能指标进行综合评估。GHD 垂体高度与rhGH
疗效存在弱负相关,临床难以依靠该指标单独预判疗效;ISS 病因异质性高,无可靠形态学预测指标,需个体化拟定rhGH 方案。 |
| 关键词: 生长激素缺乏症 特发性矮身材 重组人生长激素 垂体高度 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2026.08.003 |
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| 基金项目: |
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| Correlation Between Pituitary Height and Response to Recombinant Human Growth Hormone Therapy inChildren with Growth Hormone Deficiency and Idiopathic Short Stature |
| Zhao Xingtao1,2, Luo Jun3 |
| (1. The University of Hongkong-Shenzhen Hospital, Guangdong Shenzhen 518100, China; 2. the First
Clinical School of Jinan University, Guangzhou 510180, China; 3. Bao’an Women’s and Children’s Hospital, Guangdong Shenzhen
518102, China) |
| Abstract: |
| Objective: To explore the value of pituitary height measured by magnetic resonance imaging (MRI) in the differential
diagnosis of children with growth hormone deficiency (GHD) and idiopathic short stature (ISS), as well as its predictive significance for
the therapeutic response to recombinant human growth hormone (rhGH). Methods: A total of 106 children with short stature admitted
into the University of Hongkong-Shenzhen Hospital from Jun. 2020 to Jun. 2023 were retrospectively screened, and 75 cases (48 cases
with GHD and 27 cases with ISS) were enrolled according to inclusion and exclusion criteria. All children completed GH stimulation
test, 3. 0T pituitary MRI and serum insulin-like growth factor-1 (IGF-1) measurement, followed by standardized 12-month rhGH
treatment. Baseline data, pituitary height SDS, peak GH, difference of growth velocity (ΔGV) and difference of height standard
deviation score (ΔHt SDS) were compared between two groups. Pearson correlation analysis, univariate and multiple linear regression
were used to explore factors influencing therapeutic response. Results: The pituitary height SDS was lower in the GHD group than that in
the ISS group, without statistically significant difference (P =0. 063). The ISS group showed a wide variation range of pituitary height
SDS, indicating marked etiological heterogeneity. Peak GH concentrations in stimulation tests were significantly lower in the GHD group
than those in the ISS group (P<0. 001). After 12 months treatment, the GHD group achieved superior outcomes in ΔGV and ΔHt SDS
compared with the ISS group (P<0. 05). Pearson correlation analysis revealed a weak negative correlation between pituitary height SDS
and ΔHt SDS in the GHD group (r =-0. 31, P =0. 034), whereas no significant correlation was found in the ISS group (r =-0. 26, P =
0. 180). Univariate analysis demonstrated an correlation between younger initial treatment age and improved efficacy for GHD patients;
after multivariate adjustment, only ΔGV emerged as an independent predictor of therapeutic response (P =0. 013). None of the baseline
indicators of ISS could independently predict the efficacy. Conclusion: Pituitary height is a useful auxiliary index for GHD diagnosis,
yet it cannot be used alone to assess disease severity. Combined assessment with GH, IGF-1 and other functional markers is necessary.
Only a weak negative correlation exists between pituitary height and rhGH therapeutic response in children with GHD, making this
parameter inadequate for independent clinical prediction. Due to prominent etiological heterogeneity in ISS, no reliable morphological
predictor is available, and individualized rhGH regimens are recommended. |
| Key words: growth hormone deficiency idiopathic short stature recombinant human growth hormone pituitary height |
