垂体功能减退患者的非酒精性脂肪性肝病和代谢综合征
Nonalcoholic Fatty liver disease and metabolic syndrome in hypopituitary patients.
作者信息
Nyenwe Ebenezer A, Williamson-Baddorf Sarah, Waters Bradford, Wan Jim Y, Solomon Solomon S
机构信息
Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
出版信息
Am J Med Sci. 2009 Sep;338(3):190-5. doi: 10.1097/MAJ.0b013e3181a84bde.
BACKGROUND
Increased incidence of cardiovascular mortality and nonalcoholic fatty liver disease (NAFLD) has been reported in hypopituitarism, but previous studies did not correct for obesity in these patients. Therefore, it remained unclear if endocrine deficiency in hypopituitarism is associated with metabolic consequences independent of obesity. This study was designed to determine the burden of cardiovascular disease and NAFLD in hypopituitarism.
METHODS
We performed a retrospective case-control analysis of hypopituitary patients at Veterans Affair Medical center, Memphis, from January 1997 to June 2007. After matching for age, gender, obesity, and race, relevant data were abstracted from the subjects' records to determine the presence of hypopituitarism, cardiovascular risk factors, and fatty liver disease. Cases and controls were characterized by descriptive statistics and compared using chi(2) and Student t tests.
RESULTS
Hypopituitary patients exhibited higher prevalence of hypertension- 88% versus 78% (P < 0.03), hypertriglyceridemia-80% versus 70% (P = 0.05), low high-density lipoprotein cholesterol-84% versus 70% (P < 0.001), and metabolic syndrome-90% versus 71% (P < 0.001). Patients also had higher mean plasma glucose levels-228 +/- 152 versus 181 +/- 83 mg/dL (P < 0.01). Despite higher preponderance of cardiovascular risk factors in hypopituitary patients, prevalence of cardiovascular morbidity was similar in both groups (P > 0.3). Hypopituitary patients had higher elevations in serum aminotransferase levels and hyperbilirubinemia-24% versus 11% (P < 0.01), as well as higher international normalized ratio (INR) and hypoalbuminemia 40% versus 23% (P < 0.01).
CONCLUSIONS
There is an increased prevalence of metabolic syndrome and liver dysfunction consistent with NAFLD in hypopituitarism. Although hypopituitary patients had higher prevalence of cardiovascular risk factors than controls, they were not disproportionately affected by cardiovascular disease.
背景
垂体功能减退患者心血管疾病死亡率和非酒精性脂肪性肝病（NAFLD）的发病率有所增加，但既往研究未对这些患者的肥胖因素进行校正。因此，垂体功能减退患者的内分泌缺乏是否与独立于肥胖的代谢后果相关仍不明确。本研究旨在确定垂体功能减退患者心血管疾病和NAFLD的负担。
方法
我们对1997年1月至2007年6月在孟菲斯退伍军人事务医疗中心的垂体功能减退患者进行了一项回顾性病例对照分析。在对年龄、性别、肥胖和种族进行匹配后，从受试者记录中提取相关数据，以确定垂体功能减退、心血管危险因素和脂肪性肝病的存在情况。病例组和对照组采用描述性统计进行特征分析，并使用卡方检验和学生t检验进行比较。
结果
垂体功能减退患者的高血压患病率更高——88% 对比78%（P < 0.03），高甘油三酯血症患病率更高——80% 对比70%（P = 0.05），高密度脂蛋白胆固醇水平低的患病率更高——84% 对比70%（P < 0.001），代谢综合征患病率更高——90% 对比71%（P < 0.001）。患者的平均血浆葡萄糖水平也更高——228 ± 152对比181 ± 83 mg/dL（P < 0.01）。尽管垂体功能减退患者心血管危险因素的优势更为明显，但两组的心血管疾病发病率相似（P > 0.3）。垂体功能减退患者的血清转氨酶水平升高幅度更大，高胆红素血症患病率更高——24% 对比11%（P < 0.01），国际标准化比值（INR）更高，低白蛋白血症患病率更高——40% 对比23%（P < 0.01）。
结论
垂体功能减退患者中代谢综合征和符合NAFLD的肝功能障碍患病率增加。尽管垂体功能减退患者心血管危险因素的患病率高于对照组，但他们并未受到心血管疾病的过度影响。
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