Supplementary Material for: Can growth hormone lead to a faster recovery from Guillain-Barrée syndrome? Case report of the first therapeutic use in one patient

Although the prognosis in Guillain-Barré syndrome (GBS) is generally good, protracted and incomplete courses of recovery can be a heavy burden. Animal studies suggest growth hormone (GH) treatment could stimulate myelin repair and thus accelerate functional recovery in acute polyneuropathy. We report on the first use of GH in GBS. Our objective was to monitor safety and tolerability as well as to evaluate the effect of an off-label GH therapy during recovery from GBS in one patient. A 28-year-old male with flaccid tetraparesis caused by pure motor GBS was treated off-label with GH (1 mg/day) for 10 weeks. Muscle strength was measured regularly before, during and after the treatment over a total span of 330d. Serum levels of IGF-I were assessed before, during and after GH treatment. Changes in strength gain were used as the main parameter of efficacy. No side effects of GH treatment were observed. Serum IGF-I increased from 177 ng/mL at baseline to an average of 342 ng/mL (normal range 78 – 270 ng/mL) during treatment. Prior to GH administration, strength (R²=0.99, p<0.01) was associated with time, representing the natural course of recovery. During GH treatment, the slope of strength gain increased (Glass’ ∆=1.08, p<0.01). The association between alterations of strength gain and IGF-I serum levels reached trend-level (R²=0.36, p=0.09). In this single case, GH treatment seemed to be associated with faster muscular strength gain. Controlled studies are needed in order to establish GH as a potential therapeutic approach in motor GBS.

尽管吉兰-巴雷综合征（Guillain-Barré syndrome, GBS）的总体预后良好，但迁延不愈与恢复不完全的病程仍会带来沉重负担。动物研究显示，生长激素（growth hormone, GH）治疗可刺激髓鞘修复，进而加速急性多发性神经病的功能恢复。本研究首次报道了GH在GBS中的临床应用，旨在监测1例GBS恢复期患者接受超说明书GH治疗的安全性与耐受性，并评估其治疗效果。该患者为28岁男性，因纯运动型吉兰-巴雷综合征引发弛缓性四肢瘫痪，接受超说明书GH治疗（每日1mg，疗程10周）。在总计330天的随访周期内，研究人员于治疗前、治疗期间及治疗结束后定期评估其肌肉力量，并在GH治疗的前、中、后三个阶段检测血清胰岛素样生长因子-1（IGF-I）水平，以肌力增幅作为主要疗效评价指标。本研究未观察到GH治疗相关的不良反应。治疗期间，患者血清IGF-I水平从基线的177 ng/mL升至平均342 ng/mL（正常参考范围78~270 ng/mL）。在GH给药前，肌力与时间呈显著正相关（决定系数R²=0.99，P<0.01），对应GBS的自然恢复进程；在GH治疗期间，肌力增长的斜率显著升高（Glass’ Δ=1.08，P<0.01）；而肌力增幅与血清IGF-I水平的相关性达到趋势性显著水平（R²=0.36，P=0.09）。本单病例研究显示，GH治疗或可加快肌肉力量恢复速度，未来需开展对照研究以确立GH作为运动型GBS潜在治疗手段的可行性。