长期 GH 替代治疗对孤立性 GH 缺乏症与多种垂体激素缺乏症患者心血管结局的影响：来自荷兰成人 GH 治疗国家注册库的一项亚分析。
Effect of long-term GH replacement therapy on cardiovascular outcomes in isolated GH deficiency compared with multiple pituitary hormone deficiencies: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults.
机构信息
Section of EndocrinologyDepartment of Internal Medicine, Neuroscience Campus AmsterdamDepartment of Epidemiology and BiostatisticsVU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsDepartment of Internal MedicineIsala Clinics, Zwolle, The NetherlandsEmotional Brain and Alan Turing Institute for Multidisciplinary Health ResearchAlmere, The NetherlandsDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
Section of EndocrinologyDepartment of Internal Medicine, Neuroscience Campus AmsterdamDepartment of Epidemiology and BiostatisticsVU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsDepartment of Internal MedicineIsala Clinics, Zwolle, The NetherlandsEmotional Brain and Alan Turing Institute for Multidisciplinary Health ResearchAlmere, The NetherlandsDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
出版信息
Eur J Endocrinol. 2014 Aug;171(2):151-60. doi: 10.1530/EJE-14-0069. Epub 2014 May 6.
OBJECTIVE
Isolated GH deficiency (IGHD) could provide a model to investigate the influence of GH deficiency per se and the effect of GH replacement therapy without the influence from other pituitary hormone deficiencies or their treatment. The aim of this study is to address the questions about differences between IGHD and multiple pituitary hormone deficiencies (MPHDs) in clinical presentation and in responsiveness to GH treatment.
DESIGN
A nationwide surveillance study was carried out to describe the difference in the clinical presentation and responsiveness to GH treatment of patients with IGHD and MPHDs.
METHODS
The Dutch National Registry of GH Treatment in Adults was founded in 1998 to gain more insight into long-term efficacy and safety of GH therapy. Out of 2891 enrolled patients, 266 patients with IGHD at the start of GH treatment were identified and compared with 310 patients with MPHDs. Cardiovascular indices will be investigated at baseline and during long-term follow-up, including body composition, lipid profile, glucose metabolism, blood pressure, and morbidity.
RESULTS
Patients with IGHD and MPHDs were demonstrated to be different entities at clinical presentation. Metabolically, patients with MPHDs had a larger waist circumference, lower HDL cholesterol level, and higher triglyceride level. The effect of GH treatment was comparable between patient groups. GH seems to protect against rising lipid levels and blood pressure, even after excluding patients using corresponding concomitant medication. The risk for cardiovascular disease or diabetes mellitus during follow-up was not different between patients with IGHD and MPHDs.
CONCLUSIONS
Patients with IGHD had a less impaired metabolic profile than patients with MPHDs at baseline. Influence of other pituitary hormone replacement therapies on the effect of GH treatment is not demonstrated.
目的
孤立性生长激素缺乏症（IGHD）可提供一种模型，用于研究生长激素缺乏本身的影响以及生长激素替代治疗的效果，而不受其他垂体激素缺乏或其治疗的影响。本研究旨在探讨 IGHD 和多种垂体激素缺乏症（MPHDs）在临床表现和对生长激素治疗反应方面的差异。
设计
进行了一项全国性监测研究，以描述 IGHD 和 MPHDs 患者在临床表现和对生长激素治疗反应方面的差异。
方法
荷兰成人生长激素治疗国家注册处成立于 1998 年，旨在深入了解生长激素治疗的长期疗效和安全性。在 2891 名入组患者中，确定了 266 名开始生长激素治疗时患有 IGHD 的患者，并与 310 名患有 MPHDs 的患者进行了比较。将在基线和长期随访期间检查心血管指数，包括身体成分、血脂谱、葡萄糖代谢、血压和发病率。
结果
IGHD 和 MPHDs 患者在临床表现上表现为不同的实体。代谢方面，MPHDs 患者的腰围更大，HDL 胆固醇水平更低，甘油三酯水平更高。生长激素治疗的效果在两组患者之间相当。即使排除使用相应伴随药物的患者，生长激素似乎也能防止血脂和血压升高。在随访期间，IGHD 和 MPHDs 患者发生心血管疾病或糖尿病的风险无差异。
结论
IGHD 患者在基线时的代谢状况较 MPHDs 患者受损程度较轻。其他垂体激素替代治疗对生长激素治疗效果的影响尚未得到证实。
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