Lawson Elizabeth A, Miller Karen K, Mathur Vani A, Misra Madhusmita, Meenaghan Erinne, Herzog David B, Klibanski Anne
Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
J Clin Endocrinol Metab. 2007 Aug;92(8):3089-94. doi: 10.1210/jc.2007-0364. Epub 2007 May 22.
Cardiovascular (CV) risk markers, including high-sensitivity C-reactive protein (hsCRP), are increasingly important in predicting cardiac events. A favorable CV risk profile might be expected in anorexia nervosa (AN) due to low body weight and dietary fat intake. However, women with AN have decreased IGF-I levels reflecting decreased GH action, and IGF-I deficiency is associated with elevated hsCRP. Moreover, oral estrogens, known to increase hsCRP in other populations, are commonly prescribed in AN. To date, hsCRP levels and their physiological determinants have not been reported in women with AN.
We examined the relationship between CV risk markers, undernutrition, IGF-I, and oral estrogens, specifically hypothesizing that in the setting of undernutrition, AN would be associated with low hsCRP despite low IGF-I levels and that those women taking oral contraceptive pills (OCPs) would have higher hsCRP and lower IGF-I levels.
We conducted a cross-sectional study at a clinical research center.
Subjects included 181 women: 140 women with AN [85 not receiving OCPs (AN-E) and 55 receiving OCPs (AN+E)] and 41 healthy controls [28 not receiving OCPs (HC-E) and 13 receiving OCPs (HC+E)].
We assessed hsCRP, IL-6, IGF-I, low-density lipoprotein (LDL), and high-density lipoprotein (HDL).
Despite low weight, more than 20% of AN+E had high-risk hsCRP levels. AN+E had higher hsCRP than AN-E. AN-E had lower mean hsCRP levels than healthy controls (HC+E and HC-E). IL-6 levels were higher in AN+E with elevated hsCRP (>3 mg/liter) than in AN+E with normal hsCRP levels. IGF-I was inversely associated with hsCRP in healthy women, suggesting a protective effect of GH on CV risk. However, this was not seen in AN. Few patients in any group had high-risk LDL or HDL levels.
Although hsCRP levels are lower in AN than healthy controls, OCP use puts such women at a greater than 20% chance of having hsCRP in the high-CV-risk (>3 mg/liter) category. The elevated mean IL-6 in women with AN and high-risk hsCRP levels suggests that increased systemic inflammation may underlie the hsCRP elevation in these patients. Although OCP use in AN was associated with slightly lower mean LDL and higher mean HDL, means were within the normal range, and few patients in any group had high-risk LDL or HDL levels. IGF-I levels appear to be important determinants of hsCRP in healthy young women. In contrast, IGF-I does not appear to mediate hsCRP levels in AN.
包括高敏C反应蛋白（hsCRP）在内的心血管（CV）风险标志物在预测心脏事件方面越来越重要。由于体重低和膳食脂肪摄入量低，神经性厌食症（AN）患者可能具有良好的心血管风险特征。然而，患有AN的女性胰岛素样生长因子-I（IGF-I）水平降低，反映出生长激素（GH）作用减弱，且IGF-I缺乏与hsCRP升高有关。此外，已知在其他人群中会增加hsCRP的口服雌激素在AN患者中通常会被处方使用。迄今为止，尚未报道过AN女性患者的hsCRP水平及其生理决定因素。
我们研究了心血管风险标志物、营养不良、IGF-I和口服雌激素之间的关系，特别假设在营养不良的情况下，尽管IGF-I水平较低，但AN仍与低hsCRP相关，并且服用口服避孕药（OCP）的女性hsCRP会更高，IGF-I水平会更低。
我们在一个临床研究中心进行了一项横断面研究。
受试者包括181名女性：140名患有AN的女性[85名未服用OCP（AN-E）和55名服用OCP（AN+E）]以及41名健康对照者[28名未服用OCP（HC-E）和13名服用OCP（HC+E）]。
我们评估了hsCRP、白细胞介素-6（IL-6）、IGF-I、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）。
尽管体重较低，但超过20%的AN+E患者hsCRP水平处于高风险。AN+E的hsCRP高于AN-E。AN-E的平均hsCRP水平低于健康对照者（HC+E和HC-E）。hsCRP升高（>3mg/升）的AN+E患者的IL-6水平高于hsCRP正常的AN+E患者。在健康女性中，IGF-I与hsCRP呈负相关，表明GH对心血管风险具有保护作用。然而，在AN患者中未观察到这种情况。任何一组中很少有患者LDL或HDL水平处于高风险。
尽管AN患者的hsCRP水平低于健康对照者，但使用OCP使这类女性hsCRP处于心血管高风险（>3mg/升）类别的几率超过20%。AN患者且hsCRP水平处于高风险的女性中IL-6平均水平升高表明全身炎症增加可能是这些患者hsCRP升高的基础。尽管AN患者使用OCP与平均LDL略低和平均HDL略高有关，但平均值在正常范围内，任何一组中很少有患者LDL或HDL水平处于高风险。IGF-I水平似乎是健康年轻女性hsCRP的重要决定因素。相比之下，IGF-I似乎并未介导AN患者的hsCRP水平。
