Misra Madhusmita, Miller Karen K, Tsai Patrika, Stewart Victoria, End Alison, Freed Natalie, Herzog David B, Goldstein Mark, Riggs Suzanne, Klibanski Anne
Neuroendocrine Unit, and the Eating Disorders Unit, Child Psychiatry Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
J Pediatr. 2006 Dec;149(6):763-769. doi: 10.1016/j.jpeds.2006.08.043.
Cardiovascular (CV) risk begins in childhood, and low body weight should result in a favorable risk profile. However, adolescents with anorexia nervosa (AN) have alterations in many hormonal factors that mediate CV risk. We hypothesized that in AN, growth hormone (GH) resistance and hypercortisolemia would increase CV risk through effects on pro-inflammatory cytokines and lipid status despite low weight.
We examined CV risk markers (high sensitivity C-reactive protein [hsCRP], interleukin-6 [IL-6], apolipoprotein-B [Apo-B], and lipid profile) in 23 subjects with AN and in 20 control subjects 12 to 18 years of age, in whom GH, cortisol, leptin, and triiodothyronine (T3) had been previously determined.
Subjects with AN had higher Apo-B (P < .0001), IL-6 (P = .03), Apo-B/high-density lipoprotien (HDL) (P = .01), and Apo-B/low-density lipoprotein (LDL) (P < .0001) and lower hsCRP (P = .01) than controls. Triglycerides were lower and HDL higher in subjects with AN. IGF-I predicted hsCRP in controls but not in AN. Log hsCRP correlated positively with GH and inversely with leptin. On regression modeling, the most significant predictor of log hsCRP was leptin; T3 predicted log IL-6, log Apo-B, log Apo-B/HDL, and Apo-B/LDL; and cortisol independently predicted log Apo-B. IL-6 decreased with weight gain.
CV risk markers are uncoupled in AN, with increased Apo-B and IL-6 and decreased hsCRP, related to hormonal alterations. IL-6 normalizes with weight gain.
心血管（CV）风险始于儿童期，低体重应导致有利的风险状况。然而，神经性厌食症（AN）青少年存在许多介导CV风险的激素因素改变。我们推测，在AN中，尽管体重较低，但生长激素（GH）抵抗和高皮质醇血症会通过对促炎细胞因子和脂质状态的影响增加CV风险。
我们检测了23例AN患者和20例12至18岁对照受试者的CV风险标志物（高敏C反应蛋白[hsCRP]、白细胞介素-6[IL-6]、载脂蛋白B[Apo-B]和血脂谱），这些受试者之前已测定过GH、皮质醇、瘦素和三碘甲状腺原氨酸（T3）。
与对照组相比，AN患者的Apo-B（P <.0001）、IL-6（P =.03）、Apo-B/高密度脂蛋白（HDL）（P =.01）和Apo-B/低密度脂蛋白（LDL）（P <.0001）更高，而hsCRP更低（P =.01）。AN患者的甘油三酯更低，HDL更高。胰岛素样生长因子-I在对照组中可预测hsCRP，但在AN患者中不能。对数hsCRP与GH呈正相关，与瘦素呈负相关。在回归模型中，对数hsCRP的最显著预测因子是瘦素；T3可预测对数IL-6、对数Apo-B、对数Apo-B/HDL和Apo-B/LDL；皮质醇独立预测对数Apo-B。IL-6随体重增加而降低。
AN患者的CV风险标志物与激素改变有关，表现为Apo-B和IL-6升高，hsCRP降低。IL-6随体重增加而恢复正常。
