Mukherjee Annice, Adams Judith E, Smethurst Linda, Shalet Stephen M
Department of Endocrinology, Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK.
Eur J Endocrinol. 2005 Nov;153(5):661-8. doi: 10.1530/eje.1.02017.
Lean body mass (LBM) and total body water (TBW) are reduced in GH-deficient (GHD) adults and alter with GH replacement. Whether these parameters are interdependent and whether alterations in their homeostasis contribute to the perceived quality of life (QOL) deficit in GHD remains unclear. In this study, IGF-I, body composition by whole-body dual-energy X-ray absorptiometry, TBW by deuterium dilution (D(2)O) and two validated QOL instruments - psychological general well-being schedule (PGWB, generic, 6 domains; lower score worse QOL) and assessment of GH deficiency in adults (AGHDA, disease orientated; higher score worse QOL) were studied at baseline and after 3 and 6 months of GH replacement in thirty GHD adults. Patients with diabetes insipidus, and cardiac and renal failure were excluded. Median age-adjusted IGF-I standard deviation score increased from -3.40 (-6.40 to -1.60) to -0.2 (-1.88 to 0.78) (P < 0.0001) at a median daily GH dose of 0.4 mg. During treatment, LBM increased from 47.4 +/- 10.7 kg at baseline to 49.5 +/- 10.8 kg at 6 months (P = 0.0008), and fat mass decreased from 28.0 +/- 12.1 kg at baseline to 27.2 +/- 12.6 kg at 6 months (P = 0.0004). A non-significant trend towards an increase in TBW was observed (mean 1.7 kg, P = 0.08). The PGWB score increased from 62.9 +/- 20.6 to 73.7 +/- 21.7 (P = 0.0006). The AGHDA score decreased from 13.7 +/- 7.3 to 8.75 +/- 7.75 (P = 0.0002). At each time point, a linear correlation between LBM and TBW was demonstrated, defined by TBW = (0.972 x LBM)-10.6. However, only a weakly positive correlation existed between the percentage changes in these variables (R = 0.40, P = 0.04). No correlations were demonstrated between QOL measures and body composition. The change in LBM with physiological GH replacement correlates weakly with change in TBW, therefore factors other than TBW may also contribute to the LBM changes. Improved QOL with GH replacement is not explained by favourable changes in body composition.
生长激素缺乏（GHD）的成年人瘦体重（LBM）和总体水（TBW）减少，且会随着生长激素替代治疗而改变。这些参数是否相互依存，以及它们体内平衡的改变是否导致了GHD患者所感受到的生活质量（QOL）缺陷，目前尚不清楚。在本研究中，对30名GHD成年人在基线时以及生长激素替代治疗3个月和6个月后，进行了胰岛素样生长因子-I（IGF-I）、通过全身双能X射线吸收法测定的身体成分、通过氘稀释法（D₂O）测定的TBW以及两种经过验证的QOL评估工具——心理总体幸福感量表（PGWB，通用型，6个领域；分数越低QOL越差）和成人生长激素缺乏评估量表（AGHDA，疾病导向型；分数越高QOL越差）的研究。排除了患有尿崩症、心力衰竭和肾衰竭的患者。在每日生长激素中位剂量为0.4 mg时，年龄调整后的IGF-I标准差评分中位数从-3.40（-6.40至-1.60）增加到-0.2（-1.88至0.78）（P < 0.0001）。在治疗期间，LBM从基线时的47.4±10.7 kg增加到6个月时的49.5±10.8 kg（P = 0.0008），脂肪量从基线时的28.0±12.1 kg减少到6个月时的27.2±12.6 kg（P = 0.0004）。观察到TBW有不显著的增加趋势（平均增加1.7 kg，P = 0.08）。PGWB评分从62.9±20.6增加到73.7±21.7（P = 0.0006）。AGHDA评分从13.7±7.3降低到8.75±7.75（P = 0.0002）。在每个时间点，LBM和TBW之间都显示出线性相关性，由TBW =（0.972×LBM）-10.6定义。然而，这些变量的百分比变化之间仅存在弱正相关（R = 0.40，P = 0.04）。QOL测量值与身体成分之间未显示出相关性。生理性生长激素替代治疗导致的LBM变化与TBW变化之间的相关性较弱，因此除TBW外的其他因素也可能导致LBM的变化。生长激素替代治疗带来的QOL改善并不能用身体成分的有利变化来解释。
