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纽约时报双语:使用生长激素帮孩子长高?你应该更慎重

使用生长激素帮孩子长高?你应该更慎重
Weighing the Use of Growth Hormones for Children
JANE E. BRODY
2021年4月2日
纽约时报双语:使用生长激素帮孩子长高?你应该更慎重

An 8-year-old boy I know is small for his age, shorter and slighter than his friends, even smaller than his 5-year-old sister. Concerned about the increasing use and possible risks of growth hormone, I asked his mother if she’d considered treating him with it. She replied, “Not really. He’s built like his father, who was short and slight as a boy and didn’t shoot up until college.”

我认识的一个八岁男孩个子比同龄人矮,比他的朋友们矮,甚至还不如他五岁的妹妹高。出于对生长激素使用增加的现状及其可能风险的担忧,我询问了他的母亲,是否考虑过给他使用这种治疗办法。她回复道,“没怎么想过。他身材就跟他父亲一样,小时候又矮又瘦,直到大学才开始蹿个子。”

Their son, she said, has no sign of a hormone deficiency. “He’s in the third percentile for height and has maintained the same growth trajectory for years, so there’s no reason to do something about it,” she said. “He’s very athletic, physically capable and can keep up with his friends in other ways.”

她说他们的儿子没有激素缺乏症的迹象。“他的身高在第三百分位,而且多年来保持着同样的生长轨迹,所以没有必要干预,”她说。“他运动能力很强,身体健壮,其他方面也都赶得上他的朋友。”

His father, at 41, is now 6 feet tall, though still very slender. He recalls being a reasonably athletic child but without the physical power of his friends, making up for what he lacked in mass with speed and agility. “I enjoyed competitive sports and worked on skills others didn’t have,” he told me, and said he encourages his son to recognize and capitalize on the skills he has.

他父亲现年41岁,身高1米83,但仍十分瘦削。他回忆称小时候自己还算强健,但没有朋友们那样的体力,速度和敏捷性弥补了他块头上的不足。“我喜欢竞技运动,学会其他人所没有的技巧,”他对我说,并表示他鼓励儿子认识并充分利用自己的技能。

If only every parent with a short but healthy child approached the matter as sensibly. Experts estimate that 60 percent to 80 percent of children who are short for their age do not have a growth hormone deficiency or other medical condition that limits growth. But knowing there’s a therapy available to increase height, some parents seek a medical solution for a perceived problem, even when there is no medical abnormality. They should also know, however, that new research has linked growth hormone treatment to serious adverse health effects years later.

如果所有身材矮小但身体健康的孩子家长都能如此谨慎就好了。专家估计,60%到80%身高低于其年龄段的儿童都不存在生长激素缺乏或其他限制生长的问题。但由于知道有疗法可以让孩子长高,一些家长会就他们眼中的问题求医问诊,哪怕孩子没有出现医学上的病态。但是,他们也应该知晓,新的研究已经将生长激素疗法与多年后的严重不良健康影响联系了起来。

Undue shortness may have many causes in addition to a deficiency of growth hormone, including malnutrition, Crohn’s disease or celiac disease, and potential medical conditions should be ruled out or, if present, treated. But height is most often related to the child’s genetics. Like father or mother, like son or daughter. Given the height of my parents — a 5-foot-1 mother and a 5-foot-6 father — I was not likely to become a forward for the Knicks at 4 feet 11.

除了缺乏生长激素,造成身材过矮的可能原因有很多,包括营养不良、克罗恩病或乳糜泻,应该排除掉潜在的疾病,如果发现,应予以治疗。但身高通常与孩子的基因有关。有其父必有其子,有其母必有其女。考虑到我父母的身高(母亲1米54,父亲1米67),1米5的我不太可能成为尼克斯队的前锋。

Dr. Adda Grimberg, a pediatric endocrinologist at Children’s Hospital of Philadelphia, recalled that “20 years ago, families were focused on health. They came in with a child who was not growing right and wanted to know if there was an underlying disease. Now, more and more, they’re focused on height. They want growth hormone, looking for a specific height. But this is not like Amazon; you can’t just place an order and make a child the height you want.”

费城儿童医院(Children s Hospital of Philadelphia)的儿童内分泌学家阿达·格里姆伯格(Adda Grimberg)博士回忆道,“20年前,家庭关注的是健康。家长带着个头不对的孩子来医院,想知道的是他们是否有潜在疾病。现在,家长越来越关注身高。他们想要生长激素,长出特定的身高。但这不是亚马逊(Amazon);你不能靠下个单就把孩子的身高变成你想要的样子。”

Originally, growth hormone was used to treat children with an established deficiency, which can result in a host of serious health problems. Cadavers were the initial limited source of the hormone until 1985, when scientists succeeded in producing recombinant human growth hormone in the laboratory, greatly increasing the supply and its use to treat growth hormone deficiency.

生长激素起初被用于治疗有某种缺陷的儿童,其缺陷可能导致一系列严重的健康问题。1985年,科学家在实验室成功制造出重组生长激素,大大增加了其供应以及在治疗生长激素缺乏上的应用,而那之前,尸体才是这一激素最初的有限来源。

Estimates of the incidence of this deficiency range from one in 3,000 to one in 10,000 children. According to the Pediatric Endocrine Society, those affected are usually much shorter than their peers — well below the third percentile — and over time fall increasingly behind.

据估计,这一缺乏症的儿童发病率在3000分之一到10000分之一不等。根据儿科内分泌学会(Pediatric Endocrine Society)的数据,受此影响的人通常比同龄人矮得多(远低于第三百分位),且随着时间推移,他们的身高数据会越来越落后。

In 2003, the Food and Drug Administration approved use of recombinant human growth hormone for the condition known as “idiopathic short stature,” or short stature of unknown cause, which is not a disease. But it has prompted a growing number of parents to consider using the hormone to boost the height of their children. The resulting rush to therapy reflects concerns about a widespread societal bias against shortness, rather than a true medical need, Dr. Grimberg said.

2003年,美国食品与药品管理局(Food and Drug Administration)批准将重组生长激素用于所谓的“特发性矮小”,或不明原因矮小的问题,但这并不是疾病。这也促使越来越多的父母考虑使用该激素让孩子长高。格里姆伯格表示,由此产生的治疗热潮反映了对普遍存在的矮个偏见的担忧,而非真正的医疗需求。

Parents considering treatment for this otherwise medically benign condition should know what it entails: daily injections for years until the child’s growth is completed, rotating injection sites in the body to minimize scarring. Although few children experience side effects, which can include severe headaches and hip problems, treatment requires repeated doctor visits, X-rays and blood work and, Dr. Grimberg said, “gives the child a powerful message that there’s something wrong with him that needs fixing.”

要对医学上状况良好的孩子使用此疗法的家长需要知道它会带来怎样的后果:持续数年的每日注射,直到孩子发育结束,要不断更换身体注射部位,以最大程度地减少疤痕。虽然很少有孩子会遇到,但副作用可能包括严重头痛和髋关节问题,治疗时需要反复看医生、做X光和抽血,格里姆伯格也说,“这会传达给孩子一个强烈的信息,那就是他有些毛病需要治好。”

According to the Pediatric Endocrine Society, the decision to administer growth hormone for idiopathic short stature should be made on a case-by-case basis in which benefits and risks are carefully considered for each child.

根据儿科内分泌学会的说法,应视情况来决定是否使用生长激素治疗特发性矮小,仔细考虑到每位儿童的效益与风险。

What, then, are the benefits and risks? Although manufacturers have supported monitoring drug safety beyond the 10 years mandated by the U.S. government, reporting is voluntary and necessarily incomplete. However, a far more reliable assessment is available from Sweden, where population-wide data are routinely collected.

那么,效益与风险到底有什么呢?尽管在美国政府规定的10年时间之外,制造商仍支持继续监测药品安全,但报告是自愿且必然不完整的。不过,在频繁收集人口数据的瑞典,有项评估要可靠得多。

In JAMA Pediatrics in December, pediatric endocrinologists from Karolinska University Hospital reported that among 3,408 patients who were treated with recombinant growth hormone as children and adolescents and followed for up to 25 years, the risk of developing a cardiovascular event like a heart attack or stroke was two-thirds higher for men and twice as high for women than among 50,036 untreated but otherwise similar people.

在《美国医学会杂志·儿科》(JAMA Pediatrics)的12月刊中,卡罗林斯卡大学医院(Karolinska University Hospital)的儿科内分泌学家报告称,儿童和青少年时期进行重组生长激素治疗、并接受最长达25年随访的3408名患者,与未接受治疗但其他状况类似的50036名患者相比,男性发生诸如心脏病发作或中风等心血管事件的风险高出三分之二,女性则高出两倍。

The Swedish finding follows a report last June from a research team in Tokyo that growth hormone promotes biomedical pathways that stimulate the development of atherosclerosis, the basis for most cardiovascular events.

瑞典的这一发现是在去年6月东京研究小组发布的一份报告之后,该报告称,生长激素会增加生物医学途径,刺激动脉粥样硬化的发展,这是造成大多数心血管事件的根本原因。

Not yet known is whether other long-term adverse effects will become apparent in the years ahead. Based on its known action, giving growth hormone when no deficiency exists might raise the risk of cancer, respiratory disease and diabetes. In an editorial in JAMA Pediatrics, Dr. Grimberg wrote that “indirect evidence suggests that the potential for untoward effects of growth hormone treatment is sufficiently plausible” to warrant further study.

尚不清楚其他长期副作用会否在未来数年显现。据其已知的作用,在不存在缺陷的情况下使用生长激素可能会增加患癌症、呼吸系统疾病和糖尿病的风险。格里姆伯格在《美国医学会杂志·儿科》的一篇社论中写道,“间接证据表明,生长激素治疗可能产生的不良影响足以证明”有必要进行进一步研究。

Equally important for parents to know is how much height their children might gain from years of daily hormone injections. Though impossible to predict in advance for an individual child, the average benefit for children with idiopathic short stature is about two inches in adult height. Dr. Grimberg suggested that if there is no measurable benefit within a year of therapy, parents should consider stopping it.

同样重要的是,家长也要清楚,通过多年的每日激素注射,孩子可能会增加多少身高。虽然无法提前预测对每个孩子的影响,但特发性矮小儿童的平均治疗效益是约为五厘米的成人身高。格里姆伯格建议,如果在治疗一年内没有明显的效益,家长应该考虑停止。

In discussing the psychological aspects of growth hormone therapy when no deficiency exists, experts have noted that the practice perpetuates the notion that short stature is unacceptable, leading to a spiraling demand for therapy. It is far better, one group suggested, to help a short child develop coping skills than to buy inches through pharmacological means.

在讨论未患缺陷的情况下进行生长激素治疗的心理因素时,专家指出,这种行为延续了身材矮小不可接受的观念,导致对治疗的需求不断上升。一个研究小组建议,帮助矮个孩子培养应对技能,比用药理学手段购买身高要好得多。

In a report in Hormone Research in Pediatrics, Dr. Talia Hitt and colleagues at Children’s Hospital of Philadelphia and the University of Pennsylvania wrote that parents’ high expectations that growth hormone therapy will improve the quality of life for their children are unlikely to be met if the children are not hormone deficient. They urged clinicians to “support families in other ways that promote positive development in children with short stature.”

费城儿童医院的塔莉亚·希特(Talia Hitt)博士及其同事联合宾夕法尼亚大学在《儿科激素研究》(Hormone Research in Pediatrics)期刊发表的一份报告中写道,如果孩子没有激素缺乏,家长对生长激素疗法改善孩子生活质量的过高期待不太可能得到满足。他们敦促临床医师用其他方式来“支持家庭,以促进矮小儿童的积极发展”。

Dr. Philippa Gordon, a pediatrician in Brooklyn, N.Y., urges parents to make sure their children know “that people can be all different sizes and shapes and that their love for them is unconditional.”

纽约州布鲁克林市的儿科医生菲利帕·戈登(Philippa Gordon)博士呼吁,家长应确保他们的孩子明白,“人的体型和体态可以各不相同,而父母对他们的爱是无条件的。”

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