Parkinson C, Ryder W D, Trainer P J
Department of Endocrinology, Christie Hospital, Manchester, United Kingdom M20 4BX.
J Clin Endocrinol Metab. 2001 Nov;86(11):5240-4. doi: 10.1210/jcem.86.11.8006.
In patients with acromegaly, there is a linear association between log10 serum GH and IGF-I. Healthy females secrete three times more GH than males but have broadly similar serum IGF-I levels, and in adult GH deficiency, the dose of exogenous GH required to achieve a given serum IGF-I is significantly greater in females than males. We report the influence of gender on the relationship between serum GH and IGF-I in subjects with active acromegaly. A single, fasted, serum sample was obtained from 153 subjects with active disease (87 males; median age, 47.8 yr; range, 20-82 yr) in whom serum IGF-I was at least 30% above the upper limit of an age-related reference range after washout from medical therapy. A linear correlation between serum IGF-I and log10 serum GH was observed (r = 0.53; P < 0.0001), but this relationship was significantly influenced by gender. For a given serum GH value, females were estimated to have serum IGF-I values 82 ng/ml less than males [P < 0.02; 95% confidence interval (CI), 15.2-149]. In females receiving oral E, mean serum IGF-I for a given GH value was 130 ng/ml lower than in males (P = 0.01; 95% CI, 29.8-230.2) but only 60 ng/ml less than the remaining 45 females (NS; P = 0.2). This study demonstrates a gender difference in the relationship between serum GH and IGF-I in patients with active acromegaly consistent with relative GH resistance observed in normal and GHD females, which may, in part, be mediated by E. This observation has important implications for the use of IGF-I as a measure of disease activity.
在肢端肥大症患者中，log10血清生长激素（GH）与胰岛素样生长因子-I（IGF-I）之间存在线性关联。健康女性分泌的GH比男性多三倍，但血清IGF-I水平大致相似，并且在成人GH缺乏症中，达到给定血清IGF-I所需的外源性GH剂量在女性中显著高于男性。我们报告了性别对活动性肢端肥大症患者血清GH与IGF-I关系的影响。从153例活动性疾病患者（87例男性；中位年龄47.8岁；范围20 - 82岁）中获取单次空腹血清样本，这些患者在停止药物治疗后血清IGF-I至少比年龄相关参考范围的上限高30%。观察到血清IGF-I与log10血清GH之间存在线性相关性（r = 0.53；P < 0.0001），但这种关系受性别显著影响。对于给定的血清GH值，估计女性的血清IGF-I值比男性低82 ng/ml [P < 0.02；95%置信区间（CI），15.2 - 149]。在接受口服雌激素（E）的女性中，对于给定GH值，平均血清IGF-I比男性低130 ng/ml（P = 0.01；95% CI，29.8 - 230.2），但仅比其余45名女性低60 ng/ml（无显著性差异；P = 0.2）。本研究表明，活动性肢端肥大症患者血清GH与IGF-I之间的关系存在性别差异，这与正常和生长激素缺乏症女性中观察到的相对GH抵抗一致，这可能部分由雌激素介导。这一观察结果对使用IGF-I作为疾病活动度的衡量指标具有重要意义。
