Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
Bone Marrow Transplant. 2011 Oct;46(10):1303-8. doi: 10.1038/bmt.2010.307. Epub 2010 Dec 13.
After SCT in childhood, survivors may develop disorders of glucose metabolism. The role of obesity is controversial. We measured insulin sensitivity using the homeostasis model assessment (HOMA) and the frequently sampled i.v. glucose tolerance test (FSIVGTT), as well as body composition using dual-energy X-ray absorptiometry in 18 young adults median 18.2 years after SCT and compared them with matched controls. We also measured growth hormone (GH) secretion, and levels of leptin and adiponectin. HOMA showed insulin resistance in eight patients (44%), as opposed to none of the controls (P=0.008) and FSIVGTT showed a decreased sensitivity index in the patients (2.98 vs 4.54 mU/L/min, P=0.042). Dual energy X-ray absorptiometry showed a higher percentage fat mass in the patients (34.9 vs 24.3%, P=0.011), which correlated inversely with the sensitivity index (r=-0.52, P=0.032). The patients had a lower peak value of GH (GH(max) 9 vs 20.7 mU/L, P=0.002). Time post SCT correlated with percentage fat mass and inversely with GH(max). The patients had higher levels of leptin and lower levels of adiponectin, even after adjustment for fat mass. We propose that the decreased insulin sensitivity may primarily be explained by the adverse body composition, which may owe to long-standing GH deficiency.
在儿童时期接受 SCT 后，幸存者可能会出现葡萄糖代谢紊乱。肥胖的作用存在争议。我们使用稳态模型评估（HOMA）和频繁采样静脉葡萄糖耐量试验（FSIVGTT）测量了 18 名年轻成年人的胰岛素敏感性，这些人在 SCT 后中位数为 18.2 年，并将其与匹配的对照组进行了比较。我们还测量了生长激素（GH）分泌以及瘦素和脂联素水平。HOMA 在 8 名患者（44%）中显示出胰岛素抵抗，而对照组中没有（P=0.008），FSIVGTT 显示患者的敏感性指数降低（2.98 与 4.54 mU/L/min，P=0.042）。双能 X 射线吸收法显示患者的体脂百分比更高（34.9%比 24.3%，P=0.011），与敏感性指数呈负相关（r=-0.52，P=0.032）。患者的 GH 峰值较低（GH(max) 9 与 20.7 mU/L，P=0.002）。SCT 后时间与体脂百分比呈负相关，与 GH(max) 呈负相关。即使在调整体脂后，患者的瘦素水平较高，脂联素水平较低。我们提出，胰岛素敏感性降低可能主要归因于不良的身体成分，这可能归因于长期的 GH 缺乏。
