Metformin可增加孩童与青少年的身高


  【24drs.com】新研究认为,相较于未曾使用过metformin的同侪,较高的metformin累积剂量可以增加孩童与青少年的身高约1公分。
  
  这篇研究在线发表于9月28日JAMA小儿科期刊。
  
  加拿大Alberta大学Nicholas Kuzik等人在一篇根据孩童与青少年接受metformin累积剂量的分层分析中发现,在其中5篇研究,metformin累积剂量最高者的身高增加比较多,但是,在另外5篇研究中,最低剂量的metformin与未使用metformin的对照组则没有差异。
  
  作者们写道,就我们所知,这是首篇统合分析指出,与对照组相比,以metformin治疗可能会增加孩童与青少年的身高,特别是使用大剂量且治疗时间久时。这可能是因为比较久的治疗期间或比较高的治疗浓度造成比较大的身高变化。
  
  共有10篇研究、562名研究对象纳入统合分析,作者们观察发现,在年龄有高度变异性,这些研究的研究对象的平均年龄介于7.9-16.1岁 ,而治疗期间介于3-48个月。
  
  作者们观察发现,整体而言,metformin组与对照组的身高变化并未达统计上的显著差异,metformin治疗对整体身高的影响也是。
  
  不过,如果根据较高与较低的metformin累积剂量将研究进行分组时发现,与对照组相比,metformin剂量较高之5篇研究的孩童与青少年,治疗与身体质量指数降低有关,加权平均差异为-1.3 (95%信赖区间-2.1至-0.4),而身高增加的加权平均差异为1.0公分(95%CI为0.0 - 2.0公分),至于体重方面则未达统计上的显著差异。
  
  相对的,在另外5篇较低的metformin累积剂量与对照组的研究中,孩童与青少年的身体质量指数、身高、或体重都没有差异。
  
  如同作者们指出的,metformin累积剂量较高的5篇研究中,孩童与青少年的身高增加约1公分,这差异看起来或许不大,但是,作者们写道,这些结果依旧有临床意义。
  
  如同作者们指出的,这些研究次组分析的研究对象可能已经经历了骨骼生长板闭合,可能无法藉由metformin对增加身高提供任何治疗效果。
  
  作者们推测,因此,可以推论,在青春期给予metformin可以促进或延长正常发生之青春期引起的身高变化。针对青春期研究对象进行更长期的研究,可能可以发现使用metformin的身高增加幅度、比目前的统合分析所认为的整体增加将近1公分还要更多。
  
  资料来源:http://www.24drs.com/
  
  Native link:Metformin May Increase Height in Children, Adolescents

Metformin May Increase Height in Children, Adolescents

By Pam Harrison
Medscape Medical News

Greater cumulative exposure to metformin may increase height by a mean of approximately 1 cm in children and adolescents receiving metformin compared with peers who do not receive the drug, new research suggests.

The study was published online September 28 in JAMA Pediatrics.

Nicholas Kuzik, BSc, from the University of Alberta, Edmonton, Canada, and colleagues found that in a stratified analysis according to the cumulative dose of metformin children and adolescents had received, there was a greater increase in height among those who were treated in five studies in which the largest cumulative doses of metformin were reported, but not in another five studies in which the lowest doses of metformin were provided compared with nonmetformin controls.

"To our knowledge, this is the first meta-analysis to suggest that treatment with metformin may increase height in children and adolescents compared with a control group, particularly when a combination of large doses and longer treatment duration is used," the authors write. "It is possible that longer treatment periods or treatments concentrated at times of greater growth may lead to even greater height changes."

Some 10 studies with a total of 562 participants were included in the meta-analysis. The mean age of participants across all studies ranged from 7.9 to 16.1 years, although there was a high degree of variability in age, the authors observe. Duration of treatment was anywhere from 3 to 48 months.

"Overall, height changes were not significantly different between the metformin and control groups," the authors observe. Nor did treatment with metformin affect weight overall.

However, when studies were divided into subgroups based on higher vs lower cumulative metformin doses, the five studies in which children and adolescents were exposed to greater amounts of metformin demonstrated that treatment was associated with a decrease in body mass index at a weighted mean difference of ?1.3 (95% confidence interval, ?2.1 to ?0.4) and an increase in height at a weighted mean difference of 1.0 cm (95%CI, 0.0 - 2.0 cm) compared with control groups, although it had no significant effect on weight.

In contrast, there were no changes in body mass index, height, or weight in the other five studies in which children and adolescents were exposed to lower cumulative doses of metformin compared with controls.

As the authors note, the approximately 1-cm greater growth seen among children and adolescents enrolled in the five studies in which larger cumulative metformin doses were given may seem small, but "the findings may still be clinically meaningful," they write.

As they point out, subgroups of participants in these studies may have already experienced epiphyseal growth plate closure and would be unlikely to have additional growth from any treatment effect provided by metformin.

"Therefore, it may be speculated that metformin administration during puberty could enhance or prolong the normally occurring, puberty-induced height change," the authors speculate, adding that longer studies in pubertal participants may reveal a much larger increase in height with metformin use than the overall approximate 1-cm increase suggested by the current meta-analysis.

The authors have disclosed no relevant financial relationships.

JAMA Pediatr. Published online September 28, 2015.

    
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