Metformin可增加孩童與青少年的身高


  【24drs.com】新研究認為,相較於未曾使用過metformin的同儕,較高的metformin累積劑量可以增加孩童與青少年的身高約1公分。
  
  這篇研究線上發表於9月28日JAMA小兒科期刊。
  
  加拿大Alberta大學Nicholas Kuzik等人在一篇根據孩童與青少年接受metformin累積劑量的分層分析中發現,在其中5篇研究,metformin累積劑量最高者的身高增加比較多,但是,在另外5篇研究中,最低劑量的metformin與未使用metformin的對照組則沒有差異。
  
  作者們寫道,就我們所知,這是首篇統合分析指出,與對照組相比,以metformin治療可能會增加孩童與青少年的身高,特別是使用大劑量且治療時間久時。這可能是因為比較久的治療期間或比較高的治療濃度造成比較大的身高變化。
  
  共有10篇研究、562名研究對象納入統合分析,作者們觀察發現,在年齡有高度變異性,這些研究的研究對象的平均年齡介於7.9-16.1歲 ,而治療期間介於3-48個月。
  
  作者們觀察發現,整體而言,metformin組與對照組的身高變化並未達統計上的顯著差異,metformin治療對整體身高的影響也是。
  
  不過,如果根據較高與較低的metformin累積劑量將研究進行分組時發現,與對照組相比,metformin劑量較高之5篇研究的孩童與青少年,治療與身體質量指數降低有關,加權平均差異為-1.3 (95%信賴區間-2.1至-0.4),而身高增加的加權平均差異為1.0公分(95%CI為0.0 - 2.0公分),至於體重方面則未達統計上的顯著差異。
  
  相對的,在另外5篇較低的metformin累積劑量與對照組的研究中,孩童與青少年的身體質量指數、身高、或體重都沒有差異。
  
  如同作者們指出的,metformin累積劑量較高的5篇研究中,孩童與青少年的身高增加約1公分,這差異看起來或許不大,但是,作者們寫道,這些結果依舊有臨床意義。
  
  如同作者們指出的,這些研究次組分析的研究對象可能已經經歷了骨骼生長板閉合,可能無法藉由metformin對增加身高提供任何治療效果。
  
  作者們推測,因此,可以推論,在青春期給予metformin可以促進或延長正常發生之青春期引起的身高變化。針對青春期研究對象進行更長期的研究,可能可以發現使用metformin的身高增加幅度、比目前的統合分析所認為的整體增加將近1公分還要更多。
  
  資料來源: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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