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生長激素治療對兒童安全嗎？

生長激素療法對於患有生長激素缺乏症和其他導致身材矮小的生長障礙的兒童來說，是一種安全有效的治療方法。
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生長激素治療較常見的副作用包括頭痛、噁心和嘔吐、關節疼痛以及手腳腫脹（水腫）；然而，這些情況非常罕見。17假如出現副作用，應向醫護人員求助。
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最常見的副作用是注射部位的皮膚反應，例如疼痛、發紅、腫脹、瘙癢和瘀傷。42在同一部位重複注射可能會導致脂肪萎縮 - 由於脂肪組織受損而出現的皮膚表面凹陷。為免這種情況發生，請在每次注射轉換不同部位，以便皮膚有時間正常癒合。43

為甚麼不建議以生長激素治療特發性身材矮小？

以生長激素治療特發性身材矮小（ISS）的有效性存在爭議。對於 ISS 兒童能否在生長激素治療中得到理想的治療效果，醫學界的意見並不一致。44 ISS 兒童對生長激素治療的反應差異很大，而對治療有正面反應的兒童身高可能僅略有增長（平均增長僅4–6 厘米）。45, 46
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生長激素療法價格高昂，而效果或需要數年才能顯現，因此需要在潛在身高增長與治療費用之間作出考量。44

如果你的孩子不符合生長激素治療的條件，請與你的醫生商討其他可行的選擇。對於部分孩子，注重生活習慣（健康飲食、睡眠和身體活動）的成長計劃有顯著幫助；而其他孩子則可能需要特別醫療支援。醫生會為你的孩子建議最佳的治療方案。

有沒有不需要注射的治療方法？

促生長素是一種蛋白質分子，很容易被胃酸破壞。因此，它必須通過注射而不能口服。科學家們正在努力開發新型裝在膠囊能口服的生長激素，其他研究包括透過植入物或皮膚貼片吸收，或以氣霧劑形式吸入肺部或噴入鼻子。47, 48 這些藥物輸送方式處於不同的研究階段，尚未上市。47

我怎樣才能紓緩孩子在注射生長激素時可能感到的不適？

如果你的孩子有針頭焦慮症或表示注射時感到疼痛，你可向醫生查詢有關自動注射筆、無噪音的隱藏針或無針注射裝置，亦可考慮使用更幼的注射針或可調節注射速度的裝置。49, 50 如生長激素藥物存放於冰箱中，建議取出後先待至室溫才注射。這有助防止注射冰冷藥物所引起的疼痛。51
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此外，可嘗試以下策略來減輕與注射有關的不適和焦慮。如發現孩子出現緊張的情況，在注射期間指導孩子緩慢地進行深呼吸以放鬆情緒。亦可使用分散注意力的技巧 (看動畫片、聽音樂、玩電子遊戲)。52 選擇在有多餘脂肪的部位進行注射 – 有報告指出，腹部注射產生的疼痛比大腿注射的輕微，51 但要避免對同一部位重複進行注射，以免產生疼痛和導致難看的皮膚變化！

接受生長激素治療後，我的孩子會長多高？

並非所有兒童對生長激素治療的有相同的反應 - 有些兒童會出現迅速的生長，而另一些則身高變化很少。生長激素治療的效果取決於孩子矮小的原因和嚴重程度、孩子開始接受治療的時間以及治療持續的長度。53 你的醫生會監測你的孩子對生長激素治療的反應，並根據孩子的個別情況作出評估。

我的孩子甚麼時候可以停止生長激素治療？

生長激素治療通常會持續至你的孩子達到其最大潛在身高，以及高度增長速度減慢至一年少於 2 厘米。16 此時骨骼末端處於完全成熟的狀態（可見於生長板的閉合），因此額外的高度增加不再可能出現；另一方面，如果你的孩子在治療的第一年對生長激素治療反應欠佳 。16 你的醫生亦可能會建議提早停止治療。是否停止生長激素治療應是你與你的醫生共同作出的決定。

參考資料 

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  1. Yap F, Lee YS, Aw MM HY. Growth Assessment and Monitoring during Childhood. Ann Acad Med Singapore. 2018;47(4):149-155.
  2. Polidori N, Castorani V, Mohn A, Chiarelli F. Deciphering short stature in children. Ann Pediatr Endocrinol Metab. 2020;25(2):69-79.
  3. Rogol AD, Clark PA, Roemmich JN. Growth and pubertal development in children and adolescents: Effects of diet and physical activity. Am J Clin Nutr. 2000;72(2 SUPPL.):521S-8S.
  4. CUHK. Measuring technique. Available at https://www.cuhk.edu.hk/proj/growthstd/english/gs_measu.htm accessed on 19 Oct 2023
  5. Khadilkar V, Khadilkar A. Growth charts: A diagnostic tool. Indian J Endocrinol Metab. 2011;15 Suppl 3(Suppl3):S166-71.
  6. Haymond M, Kappelgaard AM, Czernichow P, Biller BM, Takano K, Kiess W. Early recognition of growth abnormalities permitting early intervention. Acta Paediatr. 2013;102(8):787-796.
  7. Perkins JM, Subramanian SV., Smith GD, Özaltin E. Adult height, nutrition, and population health. Nutr Rev. 2016;74(3):149-165.
  8. Vilcins D, Sly PD, Jagals P. Environmental risk factors associated with child stunting: A systematic review of the literature. Ann Glob Heal. 2018;84(4):551-562.
  9. Stanhope R, Wilks Z, Hamill G. Failure to grow: lack of food or lack of love? Prof Care Mother Child. 1994;4(8):234-237. Accessed August9, 2023. https://pubmed.ncbi.nlm.nih.gov/8680203/
  10. Rogol AD. Emotional Deprivation in Children: Growth Faltering and Reversible Hypopituitarism. Front Endocrinol (Lausanne). 2020;11:596144.
  11. Rogol AD, Hayden GF. Etiologies and early diagnosis of short stature and growth failure in children and adolescents. J Pediatr. 2014;164(5 Suppl):S1-S14.
  12. Matfin G. Chapter 42: Disorders of endocrine control of growth and metabolism. In: Pathophysiology: Concepts of Altered Health States, 7th Ed. 7th ed. Lippincott Williams & Wilkins; 2005.
  13. Lui JC, Colbert M, Cheung CSF, et al. Cartilage-Targeted IGF-1 Treatment to Promote Longitudinal Bone Growth. Mol Ther. 2019;27(3):673-680.
  14. Barstow C, Rerucha C. Evaluation of Short and Tall Stature in Children. Am Fam Physician. 2015;92(1):43-50. Accessed August9, 2023. https://pubmed.ncbi.nlm.nih.gov/26132126/
  15. Reh CS, Geffner ME. Somatotropin in the treatment of growth hormone deficiency and Turner syndrome in pediatric patients: a review. Clin Pharmacol. 2010;2(1):111-122.
  16. NICE. Human growth hormone (somatropin) for the treatment of growth failure in children. Technology appraisal guidance. Published 2010. Accessed August9, 2023. https://www.nice.org.uk/guidance/ta188
  17. Growth Hormone Research Society. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. GH Research Society. J Clin Endocrinol Metab. 2000;85(11):3990-3993.
  18. Hatfield N. Introductory Maternity and Pediatric Nursing. Wolters Kluwer Health; 2014.
  19. Barzilai R, Bronshtein M, Steinberg M, Weiner Z, Gover A. Small for gestational age: the familial perspective. J Matern Fetal Neonatal Med. 2022;35(20):3840-3844.
  20. Royal College of Obstetrics and Gynaecology. The investigation and management of the small– for–gestational–age fetus. Green-top guideline no. 31. 2nd edition. February 2013. Minor  revisions January 2014. Available at: https://www.rcog.org.uk/media/t3lmjhnl/gtg_31.pdf.  Accessed 29 July 2022.  
  21. Martin-Giacalone BA, et al. Prevalence and descriptive epidemiology of Turner syndrome in the United States, 2000-2017: A report from the National Birth Defects Prevention Network. Am J Med Genet A. 2023;191(5):1339-1349.
  22. Thayalan K, Chung K, Kothari A, Cert G. Turner syndrome – The clinical spectrum and management dilemmas. Australas J Ultrasound Med. 2018;21(4):219-226.
  23. Morgan T. Turner syndrome: Diagnosis and management. Am Fam Physician. 2007;76(3):405-410.
  24. McCandless SE, Saal HM, Braddock SR, et al. Clinical report—health supervision for children with Prader-Willi syndrome. Pediatrics. 2011;127(1):195-204.
  25. Butler MG, Miller JL, Forster JL. Prader-Willi Syndrome - Clinical Genetics, Diagnosis and Treatment Approaches: An Update. Curr Pediatr Rev. 2019;15(4):207-244.
  26. Cassidy SB, Schwartz S, Miller JL, Driscoll DJ. Prader Willi syndrome. Genet Med. 2012;14(1):10-26.
  27. Mahan JD, Warady BA; Consensus Committee. Assessment and treatment of short stature in pediatric patients with chronic kidney disease: a consensus statement. Pediatr Nephrol. 2006;21(7):917-930.
  28. Becherucci F, Roperto RM, Materassi M, Romagnani P. Chronic kidney disease in children. Clin Kidney J. 2016;9(4):583-591.
  29. Chan EYH, Yap DYH, Wong WHS, et al. Demographics and long-term outcomes of children with end-stage kidney disease: A 20-year territory-wide study. Nephrology (Carlton). 2022;27(2):171-180.
  30. Drube J, Wan M, Bonthuis M, et al. Clinical practice recommendations for growth hormone treatment in children with chronic kidney disease. Nat Rev Nephrol. 2019;15(9):577-589.
  31. Kidney International Supplements - KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Official Journal of the International Society of Nephrology. 2013;3(1).
  32. Basri H, Hadju V, Zulkifli A, et al. Dietary diversity, dietary patterns and dietary intake are associated with stunted children in Jeneponto District, Indonesia. Gac Sanit. 2021;35 Suppl 2:S483-S486.
  33. CHP. Nutritional Guideline on Lunch for students.  Available at https://school.eatsmart.gov.hk/files/pdf/lunch_guidelines_bi.pdf accessed on 19 Oct 2023
  34. Saaresranta T, Polo O. Sleep-disordered breathing and hormones. Eur Respir J. 2003;22(1):161-172.
  35. Zhou Y, ArisI M, Tan SS, et al. Sleep duration and growth outcomes across the first two years of life in the GUSTO study. Sleep Med. 2015;16(10):1281-1286.
  36. Kim TW, Jeong JH, Hong SC. The impact of sleep and circadian disturbance on hormones and metabolism. Int J Endocrinol. 2015;2015:591729.
  37. National Sleep Foundation. How Much Sleep Do You Really Need? Available at https://www.thensf.org/how-many-hours-of-sleep-do-you-really-need/ Accessed 4 August 2023.
  38. Wideman L, Weltman JY, Hartman ML, Veldhuis JD, Weltman A. Growth hormone release during acute and chronic aerobic and resistance exercise: recent findings. Sport Med. 2002;32(15):987-1004.
  39. World Health Organization. Physical activity. https://www.who.int/news-room/fact-sheets/detail/physical-activity
  40. Cilluffo G, Ferrante G, Fasola S, et al. Direct and indirect effects of Growth Hormone Deficiency (GHD) on lung function in children: A mediation analysis. Respir Med. 2018;137:61-69.
  41. Tanaka T, Sato T, Yuasa A, Akiyama T, Tawseef A. Patient preferences for growth hormone treatment in Japanese children. Pediatr Int. 2021;63(10):1185-1191.
  42. Krysiak R, Gdula-Dymek A, Bednarska-Czerwińska A, Okopień B. Growth hormone therapy in children and adults. Pharmacol Rep. 2007;59:500-516. Accessed August9, 2023. https://pubmed.ncbi.nlm.nih.gov/18048950/
  43. Chhiba PD, Sega lD. Lipoatrophy associated with daily growth hormone injections. Endocrinol Diabetes Metab Case Reports. 2021;2021(1):21-0087.
  44. Lee JM, Davis MM, Clark SJ et al. Estimated Cost-effectiveness of Growth Hormone Therapy for Idiopathic Short Stature. Arch Pediatr Adolesc Med. 2006;160:263-269.
  45. Deodati A, Cianfarani S. Impact of growth hormone therapy on adult height of children with idiopathic short stature: systematic review. BMJ. 2011;342:c7157.
  46. Finkelstein BS, Imperiale TF, Speroff T, Marrero U, Radcliffe DJ, Cuttler L. Effect of Growth Hormone Therapy on Height in Children With Idiopathic Short Stature: A Meta-analysis. Arch Pediatr Adolesc Med. 2002;156(3):230-240.
  47. Cázares-Delgadillo J, Ganem-Rondero A, Kalia YN. Human growth hormone: new delivery systems, alternative routes of administration, and their pharmacological relevance. Eur J Pharm Biopharm. 2011;78(2):278-288.
  48. Ghasemi R, Abdollahi M, Emamgholi Zadeh E, et al. mPEG-PLA and PLA-PEG-PLA nanoparticles as new carriers for delivery of recombinant human Growth Hormone (rhGH). Sci Rep. 2018;8:9854.
  49. Main K, Jorgensen J, Herte lN, Jensen S, Jakobsen L. Automatic needle insertion diminishes pain during growth hormone injection. Acta Paediatr. 1995;84(3):331-334.
  50. Dumas H, Panayiotopoulos P, Parker D, Pongpairochana V. Understanding and meeting the needs of those using growth hormone injection devices. BMC Endocr Disord. 2006;6(5).
  51. St Clair-Jones A, Prignano F, Goncalves J, Paul M, Sewerin P. Understanding and Minimising Injection-Site Pain Following Subcutaneous Administration of Biologics: A Narrative Review. Rheumatol Ther. 2020;7(4):741-757.
  52. Birnie KA, et al. Psychological interventions for needle-related procedural pain and distress in  children and adolescents. Cochrane Database Syst Rev. 2018;2018:CD005179.
  53. Wit JM, et al. Achieving optimal short- and long-term responses to paediatric growth hormone  therapy. J Clin Res Pediatr Endocrinol. 2019;11:329-40.

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