Division of Endocrinology, Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, via S Pansini 5, 80131 Naples, Italy.
Obes Surg. 2010 Feb;20(2):211-20. doi: 10.1007/s11695-009-9926-3. Epub 2009 Jul 28.
The aim of this observational study was to determine, in a retrospective analysis, whether growth hormone (GH) and insulin-like growth factor-1 (IGF-1) at baseline or changes in the GH/IGF-1 axis after laparoscopic adjustable gastric banding (LAGB) is associated with weight loss and body composition changes in severely obese nondiabetic patients.
Weight loss (expressed as percent excess weight loss [EWL%]), anthropometry, body composition by bioelectrical impedance analysis (BIA), serum IGF-1, and GH peak after GH-releasing hormone (GHRH) plus arginine (ARG) test were measured and expressed as standard deviation scores (SDS) of reference values in 104 women and 36 men, age (mean +/- SD) 34 +/- 11 and 30.2 +/- 11 years, and BMI 44 +/- 5.7 and 39 +/- 3.2, respectively, before and 6 months after LAGB.
After LAGB, 25% of women and 22.5% of men had GH deficiency, while 30.8% of women and 33.3% of men had IGF-1 deficiency or insufficiency. The median EWL was 36.8% in women and 40.0% in men. In both genders, percent decrease of waist circumference, EWL, and fat mass (FM) and percent increase of fat-free mass (FFM) was greater in patients with normal GH secretion and IGF-1 levels. The GH peak after GHRH + ARG, IGF-1 levels, and IGF-1 SDS were inversely correlated with EWL% (r = -0.50, r = -0.53, and r = -0.42, respectively; p < 0.0001) and percent FM (r = -0.41, r = -0.36, and r = -0.35, respectively; p < 0.0001). In stepwise linear regression analysis, the GH peak after GHRH + ARG was the major determinant of EWL% (p < 0.0001) and FM (p = 0.001).
The efficacy of LAGB was greater in the patients with a normal GH response to GHRH + ARG and with normal IGF-1 levels. The percent of FM, FFM, and EWL were significantly correlated with the GH response to GHRH + ARG and with IGF-1 levels.
本观察性研究旨在通过回顾性分析确定，在腹腔镜可调节胃束带术（LAGB）前后生长激素（GH）和胰岛素样生长因子-1（IGF-1）的基线水平或 GH/IGF-1 轴的变化是否与非糖尿病肥胖患者的体重减轻和身体成分变化相关。
在 104 名女性和 36 名男性中，通过测量体重减轻（以超重体重减轻百分比[EWL%]表示）、人体测量、生物电阻抗分析（BIA）的身体成分、血清 IGF-1 和 GH 释放激素（GHRH）加精氨酸（ARG）试验后的 GH 峰值，并表示为参考值的标准偏差分数（SDS），年龄（均值±SD）分别为 34±11 和 30.2±11 岁，体重指数（BMI）分别为 44±5.7 和 39±3.2，分别在 LAGB 前后 6 个月进行测量。
LAGB 后，25%的女性和 22.5%的男性出现 GH 缺乏，而 30.8%的女性和 33.3%的男性出现 IGF-1 缺乏或不足。女性的中位 EWL 为 36.8%，男性为 40.0%。在两种性别中，GH 分泌正常和 IGF-1 水平正常的患者腰围、EWL、脂肪量（FM）的百分比下降和去脂体重（FFM）的百分比增加更大。GHRH+ARG 后 GH 峰值、IGF-1 水平和 IGF-1 SDS 与 EWL%（r=-0.50，r=-0.53，r=-0.42；p<0.0001）和 FM 百分比（r=-0.41，r=-0.36，r=-0.35；p<0.0001）呈负相关。逐步线性回归分析表明，GHRH+ARG 后 GH 峰值是 EWL%（p<0.0001）和 FM（p=0.001）的主要决定因素。
GHRH+ARG 后 GH 反应正常和 IGF-1 水平正常的患者 LAGB 疗效更好。FM、FFM 和 EWL 的百分比与 GHRH+ARG 后的 GH 反应和 IGF-1 水平显著相关。
