Barahona María-José, Sucunza Nuria, Resmini Eugenia, Fernández-Real José-Manuel, Ricart Wifredo, Moreno-Navarrete José-María, Puig Teresa, Farrerons Jordi, Webb Susan M
Department of Endocrinology, Hospital Mútua de Terrassa, Pl Dr Robert 5, 08221 Terrassa, Barcelona, Spain.
J Clin Endocrinol Metab. 2009 Sep;94(9):3365-71. doi: 10.1210/jc.2009-0766. Epub 2009 Jun 9.
Although increased central fat mass is characteristic of active Cushing's syndrome (CS), little is known about body composition and secretion of adipokines after long-term recovery of CS. The aim of this study was to evaluate central fat mass and its correlation with adipokines and cardiovascular risk factors in patients after long-term remission of CS.
Thirty-seven women with CS in remission (27 of pituitary and 10 of adrenal origin; mean age, 50 +/- 14 yr; mean time of hormonal cure, 11 +/- 6 yr) were enrolled and compared to 14 women with active CS and 85 gender-, age-, and body mass index-matched healthy controls. Total and trunk fat mass were measured by dual-energy x-ray absorptiometry scanning. Laboratory parameters and adipokine levels [including adiponectin, visfatin, soluble TNFalpha-receptor 1 (sTNF-R1), sTNF-R2, and IL-6] were measured.
Cured CS patients had more total and trunk fat mass than controls. Cured and active CS had higher levels of sTNF-R1 and IL-6 and lower adiponectin levels than controls. Higher insulin levels and blood pressure in both groups of CS patients and higher apolipoprotein B in cured CS were observed compared to controls. sTNF-R1 correlated positively with percentage of trunk fat mass and remained significant after adjusting for anthropometric parameters.
Despite long-term cure, patients who have suffered CS exhibit persistent accumulation of central fat, as in active hypercortisolemia, with the consequent unfavorable adipokine profile, leading to a state of low-grade inflammation. This situation determines a persistent and increased cardiovascular risk in these patients.
尽管中心性脂肪量增加是活动性库欣综合征（CS）的特征，但关于CS长期缓解后的身体组成和脂肪因子分泌情况知之甚少。本研究的目的是评估CS长期缓解患者的中心性脂肪量及其与脂肪因子和心血管危险因素的相关性。
纳入37例缓解期CS女性患者（垂体性27例，肾上腺性10例；平均年龄50±14岁；激素治愈平均时间11±6年），并与14例活动性CS女性患者和85例性别、年龄和体重指数匹配的健康对照进行比较。通过双能X线吸收法扫描测量全身和躯干脂肪量。检测实验室参数和脂肪因子水平[包括脂联素、内脂素、可溶性肿瘤坏死因子α受体1（sTNF-R1）、sTNF-R2和白细胞介素-6]。
治愈的CS患者全身和躯干脂肪量高于对照组。与对照组相比，治愈和活动性CS患者的sTNF-R1和白细胞介素-6水平较高，脂联素水平较低。与对照组相比，两组CS患者的胰岛素水平和血压较高，治愈的CS患者载脂蛋白B较高。sTNF-R1与躯干脂肪量百分比呈正相关，在调整人体测量参数后仍具有显著性。
尽管CS已长期治愈，但曾患CS的患者仍表现出中心性脂肪持续堆积，如同活动性高皮质醇血症一样，随之而来的是不利的脂肪因子谱，导致低度炎症状态。这种情况决定了这些患者持续且增加的心血管风险。
