Benedini S, Dalle Carbonare L, Albiger N, Scanarini M, Bilora F, Petrobelli F, Giannini S, Mantero F, Scaroni C
Endocrine Unit, Dept. of Medical and Surgical Sciences, University of Padua, Italy.
Horm Metab Res. 2006 Jan;38(1):16-21. doi: 10.1055/s-2006-924970.
This study examines the effects of growth hormone replacement on body composition, insulin sensitivity, lipid profile, endothelial dysfunction and carotid intima media thickness in patients with adult-onset growth-hormone (GH) deficiency.
Twelve patients with severe GH deficiency received GH replacement for one year. In all patients, the following parameters were evaluated before and after six and twelve months of therapy: fasting glucose, insulin levels and lipid profile, bone mineral density and body composition. Carotid intima media thickness and brachial flow-mediated dilatation were also evaluated by arterial ultrasonography at basal condition and after one year of therapy.
No significant changes were seen in body weight and blood pressure, total fat and lean mass, or bone mineral density after six months of GH replacement. There was an increase in triglycerides (p = 0.05), while total and HDL cholesterol, blood glucose, insulin levels did not change significantly. After twelve months, an increase in lean mass and a decrease in fat mass (p < 0.01 vs. baseline), a decrease in insulin resistance (p < 0.01 vs. six months; p = 0.01 vs. baseline) and a decrease in triglycerides (p < 0.01) were observed. Intima media thickness was greater in GH deficiency than in controls (p = 0.01) before therapy, and was unchanged after twelve months of therapy, whereas the flow-mediated dilatation tended to improve (p = 0.05).
GH replacement is able to reverse typical metabolic and body composition alterations in patients with adult GH deficiency after twelve months, but it is unable to revert the vascular alteration completely. Flow-mediated dilatation seems to be a more precocious marker of the remission of arterial damage.
本研究探讨生长激素替代治疗对成年起病的生长激素（GH）缺乏患者身体成分、胰岛素敏感性、血脂谱、内皮功能障碍及颈动脉内膜中层厚度的影响。
12例严重GH缺乏患者接受GH替代治疗1年。所有患者在治疗6个月和12个月前后评估以下参数：空腹血糖、胰岛素水平和血脂谱、骨密度和身体成分。在基础状态和治疗1年后，还通过动脉超声评估颈动脉内膜中层厚度和肱动脉血流介导的扩张。
GH替代治疗6个月后，体重、血压、总脂肪和瘦体重或骨密度均无显著变化。甘油三酯升高（p = 0.05），而总胆固醇和高密度脂蛋白胆固醇、血糖、胰岛素水平无显著变化。12个月后，观察到瘦体重增加，脂肪量减少（与基线相比，p < 0.01），胰岛素抵抗降低（与6个月相比，p < 0.01；与基线相比，p = 0.01），甘油三酯降低（p < 0.01）。治疗前，GH缺乏患者的内膜中层厚度大于对照组（p = 0.01），治疗12个月后无变化，而血流介导的扩张有改善趋势（p = 0.05）。
GH替代治疗12个月后能够逆转成年GH缺乏患者典型的代谢和身体成分改变，但不能完全逆转血管改变。血流介导的扩张似乎是动脉损伤缓解的更早期标志物。
