库欣综合征和生长激素缺乏症的代谢表型特征：一项关于身体成分和能量代谢的研究。
Characterization of the metabolic phenotypes of Cushing's syndrome and growth hormone deficiency: a study of body composition and energy metabolism.
作者信息
Burt Morton G, Gibney James, Ho Ken K Y
机构信息
Pituitary Research Unit, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia.
出版信息
Clin Endocrinol (Oxf). 2006 Apr;64(4):436-43. doi: 10.1111/j.1365-2265.2006.02488.x.
OBJECTIVE
A comparison of the severity and distribution of perturbations in body composition and their relationship to energy metabolism in glucocorticoid excess and GH deficiency (GHD) has not been undertaken before. The aim of this study was to investigate the impact of Cushing's syndrome (CS) and GHD on whole and regional body composition and energy metabolism.
DESIGN
Cross-sectional study design.
PATIENTS
Eighteen subjects with CS (12 women, aged = 41.5 +/- 3.0 years, 24-h urinary free cortisol = 1601 +/- 361 nmol/day, normal < 300 nmol/day), 22 subjects with GHD (14 women, age = 42.9 +/- 2.9 years) and 18 normal subjects (11 women, age = 46.8 +/- 2.8 years).
MEASUREMENTS
Lean body mass (LBM), fat mass (FM) and regional body composition were assessed by dual-energy X-ray absorptiometry (DEXA). Resting energy expenditure (REE) and fat oxidation (Fox) were assessed by indirect calorimetry.
RESULTS
Mean percentage FM was significantly greater by 30% in CS (P = 0.002) and 22% in GH-deficient subjects (P = 0.014) than in normal subjects. LBM was significantly lower by 15% in CS (P = 0.002) and 11% in GHD (P = 0.013). In CS, the proportion of lean tissue in the limbs was 12% less than in normal (P = 0.001) and GH-deficient subjects (P = 0.0005). Truncal fat represented a greater proportion of total FM in CS (52.5 +/- 1.8%vs. 46.9 +/- 1.3%, P = 0.014) than in normal subjects, but not in GHD. REE and Fox, corrected for LBM, were significantly lower in GHD (P < 0.02 for both vs. normal) but not in CS.
CONCLUSION
FM was higher and LBM lower in both CS and GHD. However, there is a greater abnormality of regional body composition in patients with CS who exhibit a lower limb lean mass and a greater truncal fat. Reduced REE and Fox contribute to increased adiposity in GHD. As REE and Fox are not perturbed in CS, other mechanisms must explain the marked gain in truncal and total fat.
目的
以往尚未对糖皮质激素过多和生长激素缺乏（GHD）状态下身体成分紊乱的严重程度、分布情况及其与能量代谢的关系进行比较。本研究旨在探讨库欣综合征（CS）和GHD对全身及局部身体成分和能量代谢的影响。
设计
横断面研究设计。
患者
18例CS患者（12例女性，年龄=41.5±3.0岁，24小时尿游离皮质醇=1601±361 nmol/天，正常<300 nmol/天），22例GHD患者（14例女性，年龄=42.9±2.9岁）和18例正常受试者（11例女性，年龄=46.8±2.8岁）。
测量
采用双能X线吸收法（DEXA）评估去脂体重（LBM）、脂肪量（FM）和局部身体成分。通过间接测热法评估静息能量消耗（REE）和脂肪氧化（Fox）。
结果
CS患者的平均FM百分比显著高于正常受试者30%（P=0.002），GHD患者高于正常受试者22%（P=0.014）。CS患者的LBM显著低于正常受试者15%（P=0.002），GHD患者低于正常受试者11%（P=0.013）。在CS患者中，四肢瘦组织比例比正常受试者低12%（P=0.001），比GHD患者低12%（P=0.0005）。与正常受试者相比，CS患者躯干脂肪占总FM的比例更高（52.5±1.8%对46.9±1.3%，P=0.014），但GHD患者并非如此。校正LBM后，GHD患者的REE和Fox显著低于正常受试者（两者与正常受试者相比P<0.02），但CS患者并非如此。
结论
CS和GHD患者的FM均较高，LBM均较低。然而，CS患者的局部身体成分异常更为明显，表现为下肢瘦体重较低和躯干脂肪较多。REE和Fox降低导致GHD患者肥胖增加。由于CS患者的REE和Fox未受影响，其他机制必定可以解释躯干和总脂肪的显著增加。
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