Johannsson G
Research Center for Endocrinology and Metabolism, Sahlgrenska University Hospital, Göteborg, Sweden.
J Pediatr Endocrinol Metab. 2000;13 Suppl 6:1321-6. doi: 10.1515/jpem-2000-s603.
Continuing growth hormone (GH) replacement therapy in patients with childhood-onset GH deficiency (GHD) that persists into adulthood is an emerging issue. The prospective, long-term metabolic consequences of discontinuing GH therapy in adolescent patients with childhood-onset GHD and short stature have only recently been reported. These studies demonstrate that serum concentrations of total cholesterol, low-density lipoprotein-cholesterol and apolipoprotein B are higher in adolescents in whom severe GHD continues into adulthood. Upon discontinuation of GH therapy, serum concentrations of high-density lipoprotein-cholesterol have been found to decrease in patients with severe GHD and increase in patients regarded as GH sufficient when retested for GHD. Furthermore, total body fat and truncal fat mass increase after discontinuation of GH in both these patient groups, but more markedly in the patients with severe GHD. In adolescents with severe GHD persisting into adulthood, the discontinuation of GH therapy produces, over a period of 2 years, the accumulation of important cardiovascular risk factors that are associated with GHD in adults. Continuing replacement therapy into adulthood should therefore be considered.
对于童年期起病的生长激素缺乏症（GHD）且病情持续至成年期的患者，继续进行生长激素（GH）替代治疗是一个新出现的问题。关于童年期起病的GHD且身材矮小的青少年患者停用GH治疗的前瞻性、长期代谢后果，直到最近才有报道。这些研究表明，严重GHD持续至成年期的青少年血清总胆固醇、低密度脂蛋白胆固醇和载脂蛋白B浓度较高。在停用GH治疗后，发现严重GHD患者的血清高密度脂蛋白胆固醇浓度降低，而重新检测GHD时被视为GH充足的患者血清高密度脂蛋白胆固醇浓度升高。此外，在这两组患者中，停用GH后全身脂肪和躯干脂肪量均增加，但在严重GHD患者中更为明显。对于严重GHD持续至成年期的青少年，停用GH治疗在2年时间内会产生与成人GHD相关的重要心血管危险因素的累积。因此，应考虑在成年期继续进行替代治疗。
