Fideleff H L, Boquete H R, Stalldecker G, Giaccio A V, Sobrado P G V
Endocrinology Unit-Department of Medicine, Hospital T. Alvarez, Aranguren 2701 (C1406FWY), Buenos Aires, Argentina.
Growth Horm IGF Res. 2008 Aug;18(4):318-24. doi: 10.1016/j.ghir.2008.01.002. Epub 2008 Mar 4.
To evaluate the long-term evolution of cardiovascular parameters, lipid metabolism, body composition and bone mass in untreated and treated adult growth hormone deficient patients (AGHD) comparing the differences between the two groups and within each group.
Seventy-one AGHD-patients were enrolled; 48 received growth hormone (GH) therapy: treated group (TG) and 23 received no GH therapy: control group (CG). In the TG, 22 were childhood-onset (CO) GH-deficient patients, 18-44 years (12 males) and 26 were adult-onset (AO) GH-deficient patients, 27-66 years (10 males). In the CG, 10 patients were AGHD-CO, 20-43 years (8 males) and 13 were AGHD-AO, 25-70 years (8 males). For patients in the TG, GH was administered at a starting dose of 0.1mg/day, adjusted to maintain IGF-I levels between 0 and 2 SDS for gender and age. At baseline and during the 4th year of replacement therapy or follow-up, the following parameters were evaluated: body mass index, waist circumference, blood glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, total cholesterol/HDL-cholesterol ratio, systolic and diastolic blood pressure, 2-D echocardiogram with mitral Doppler, bone mineral density (total body, lumbar spine, and femoral neck), bone mineral content (BMC) and body composition.
In the TG, there was a decrease in diastolic blood pressure (-4.0+/-1.8 mmHg, p<0.035) and an increase in blood glucose levels (0.58+/-0.19 mmol/L, p<0.025), bone mineral content (0.2+/-0.0 kg, p<0.015) and bone mineral density of lumbar spine (0.3+/-0.1 SDS, p<0.015) and femoral neck (0.4+/-0.1 SDS, p<0.001). All other variables did not show significant changes in any of the two groups. At year 4, changes (delta) differed between patients in the TG and those in the CG with regard to cholesterol levels (TG: -0.27+/-0.16 mmol/L, CG: 0.34+/-0.23 mmol/L, p<0.045), blood glucose (TG: 0.58+/-0.19 mmol/L, CG: -0.12+/-0.19 mmol/L, p<0.025) and BMC (TG: 0.2+/-0.0 g, CG: 0.0+/-0.0 g, p<0.015). An assessment of the changes in variables over time, with and without therapy, considering CO and AO separately, revealed a significant difference in total cholesterol levels during year 4 in CO patients CO (TG: -0.28+/-0.25 mmol/L and CG: 0.84+/-0.25 mmol/L, p<0.015). No differences related to the time of onset of GHD were found in changes in the remaining variables studied. There were no differences related to gender, GHD etiology or the presence of other pituitary hormone deficiencies in the evolution of the parameters analyzed.
Our 4-year study in GH deficient adults showed significant beneficial effects on some cardiovascular risk parameters and BMC in treated patients. However, there are still unsettled issues regarding long-term benefits and these patients should be carefully monitored.
评估未经治疗和接受治疗的成年生长激素缺乏患者（AGHD）的心血管参数、脂质代谢、身体成分和骨量的长期演变情况，比较两组之间以及每组内部的差异。
招募了71名AGHD患者；48名接受生长激素（GH）治疗：治疗组（TG），23名未接受GH治疗：对照组（CG）。在TG组中，22名是儿童期起病（CO）的GH缺乏患者，年龄18 - 44岁（12名男性），26名是成年期起病（AO）的GH缺乏患者，年龄27 - 66岁（10名男性）。在CG组中，10名患者是AGHD - CO，年龄20 - 43岁（8名男性），13名是AGHD - AO，年龄25 - 70岁（8名男性）。对于TG组的患者，GH起始剂量为0.1mg/天，根据性别和年龄调整剂量以维持IGF - I水平在0至2 SDS之间。在基线以及替代治疗或随访的第4年，评估以下参数：体重指数、腰围、血糖、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、总胆固醇/高密度脂蛋白胆固醇比值、收缩压和舒张压、二尖瓣多普勒二维超声心动图、骨矿物质密度（全身、腰椎和股骨颈）、骨矿物质含量（BMC）和身体成分。
在TG组中，舒张压下降（-4.0±1.8 mmHg，p<0.035），血糖水平升高（0.58±0.19 mmol/L，p<0.025），骨矿物质含量增加（0.2±0.0 kg，p<0.015），腰椎骨矿物质密度增加（0.3±0.1 SDS，p<0.015），股骨颈骨矿物质密度增加（0.4±0.1 SDS，p<0.001）。两组中的所有其他变量均未显示出显著变化。在第4年时，TG组和CG组患者在胆固醇水平（TG：-0.27±0.16 mmol/L，CG：0.34±0.23 mmol/L，p<0.045）、血糖（TG：0.58±0.19 mmol/L，CG：-0.12±0.19 mmol/L，p<0.025）和BMC（TG：0.2±0.0 g，CG：0.0±0.0 g，p<0.015）方面的变化（δ）存在差异。分别考虑CO和AO，对有治疗和无治疗情况下变量随时间的变化进行评估，发现CO患者在第4年时总胆固醇水平存在显著差异（TG：-0.28±0.25 mmol/L，CG：0.84±0.25 mmol/L，p<0.015）。在所研究的其余变量变化中，未发现与GHD起病时间相关的差异。在分析的参数演变中，未发现与性别、GHD病因或其他垂体激素缺乏的存在相关的差异。
我们对GH缺乏成年人进行的4年研究表明，治疗患者在一些心血管风险参数和BMC方面有显著的有益效果。然而，关于长期益处仍存在未解决的问题，应对这些患者进行仔细监测。
