Endocrinology/Medicine Department, Instituto de Investigación Biomédica-Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras, Unidad 747, ISCIII, Universitat Autonoma de Barcelona, Barcelona, Spain.
Horm Metab Res. 2010 Jul;42(8):613-8. doi: 10.1055/s-0030-1255032. Epub 2010 May 31.
Exposure to chronic glucocorticoid (GC) excess determines changes in body composition. The aim of the study was to compare body composition in women exposed to endogenous hypercortisolism (Cushing's syndrome, CS), exogenous glucocorticoid treatment (rheumatoid arthritis, RA) and controls. Fifty-one CS women, 26 RA women treated with low-dose prednisone (5 mg/day or 10 mg/2 days), and 78 female controls were included. Fourteen CS patients were hypercortisolemic, 37 in remission (10 required hydrocortisone substitution after surgery). Body composition parameters were measured by dual-energy X-ray absorptiometry scanning (DEXA). RA patients had a greater waist-hip ratio (WHR) (p<0.01), less lean body mass (LBM) (p<0.01), and lumbar bone mineral density (BMD) (p<0.01) than controls. CS patients, globally and those with cured disease, had more total fat (both percentage and kg) and trunk fat percentage, and less whole body-BMD than RA patients (p<0.05, p<0.01, p<0.05, respectively). Active CS patients had less whole body-BMD and more LBM than RA patients (p<0.05, p=0.01, respectively). Cured CS patients not taking hydrocortisone had more total fat [both percentage (p<0.05) and kg (p<0.05)], trunk fat percentage (p<0.05), lumbar BMD (p<0.01) than RA patients. Cured CS patients requiring hydrocortisone only differed from RA patients by smaller WHR (p<0.01). All the differences in BMD disappeared when the data were reanalyzed including only the estrogen-deficient groups. Hypercortisoliof CS determines an irreversible increase in body fat, greater than in RA. Endogenous and exogenous exposure to GC negatively affects body composition by increasing the WHR. There appears to be no additional effect on BMD in estrogen-deficient women.
长期暴露于糖皮质激素（GC）会导致身体成分发生变化。本研究旨在比较内源性皮质醇过多症（库欣综合征，CS）、外源性糖皮质激素治疗（类风湿关节炎，RA）和对照组妇女的身体成分。纳入了 51 名 CS 女性、26 名接受低剂量泼尼松（5mg/天或 10mg/2 天）治疗的 RA 女性和 78 名女性对照组。14 名 CS 患者存在高皮质醇血症，37 名处于缓解期（手术后 10 名需要氢化可的松替代治疗）。通过双能 X 射线吸收法（DEXA）测量身体成分参数。RA 患者的腰围-臀围比（WHR）更大（p<0.01），瘦体重（LBM）更少（p<0.01），腰椎骨密度（BMD）更低（p<0.01）。与 RA 患者相比，CS 患者，总体上和疾病已治愈的 CS 患者，具有更多的总脂肪（百分比和 kg）和躯干脂肪百分比，以及更少的全身 BMD（p<0.05，p<0.01，p<0.05，分别）。活动期 CS 患者的全身 BMD 和 LBM 均少于 RA 患者（p<0.05，p=0.01，分别）。不服用氢化可的松的已治愈 CS 患者的总脂肪（百分比（p<0.05）和 kg（p<0.05））、躯干脂肪百分比（p<0.05）、腰椎 BMD（p<0.01）更多，与 RA 患者相比。仅接受氢化可的松治疗的已治愈 CS 患者与 RA 患者的唯一区别是 WHR 较小（p<0.01）。当仅包括雌激素缺乏组重新分析数据时，所有 BMD 差异均消失。CS 的高皮质醇血症导致体脂增加，大于 RA。内源性和外源性 GC 暴露通过增加 WHR 对身体成分产生负面影响。在雌激素缺乏的女性中，似乎对 BMD 没有额外的影响。
