Wagenmakers Margreet, Roerink Sean, Gil Linda, Plantinga Theo, Smit Jan, Netea-Maier Romana, Hermus Ad
Department of Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Clin Endocrinol (Oxf). 2015 Feb;82(2):180-7. doi: 10.1111/cen.12639. Epub 2014 Dec 4.
Centripetal obesity is associated with systemic low-grade inflammation and an increased cardiovascular risk. Patients in long-term remission of Cushing's syndrome (CS) report persisting abdominal fat accumulation. However, this has previously not been adequately objectified. Therefore, we investigated the adipose tissue distribution and adipocytokine profiles of patients in long-term remission of CS.
Cross-sectional case-control study in a tertiary referral centre.
Fifty-eight patients, in remission of CS for at least 5 years, were compared to 58 age-, gender- and BMI-matched healthy control subjects.
Measures of body composition (assessed with clinical evaluation and dual-energy X-ray absorptiometry (DEXA) scanning) and serum adipocytokine profiles.
Compared to the matched control subjects, patients in long-term remission of CS had a greater waist circumference (P < 0·01), a smaller thigh circumference (P < 0·01), a higher waist-to-hip ratio (P < 0·01) and a higher hip-to-thigh ratio (P < 0·01). As measured with DEXA scanning, patients had a higher percentage of truncal fat mass (P = 0·01), and the truncal fat mass to leg fat mass ratio was greater (P < 0·01). Patients had lower adiponectin levels (P < 0·01), higher leptin levels (P < 0·01) and higher resistin levels (P = 0·04) than control subjects.
Even after long-term remission, patients who suffered from CS in the past continue to have a centripetal adipose tissue distribution and an adverse adipokine profile. This is independent of aetiology of the CS, treatment strategies, hormonal deficiencies and comorbidity, and probably contributes to the persistent increased cardiovascular risk.
向心性肥胖与全身低度炎症及心血管风险增加相关。库欣综合征（CS）长期缓解的患者报告存在持续性腹部脂肪堆积。然而，此前这一点尚未得到充分客观化验证。因此，我们研究了CS长期缓解患者的脂肪组织分布和脂肪细胞因子谱。
在一家三级转诊中心进行的横断面病例对照研究。
58例CS缓解至少5年的患者与58例年龄、性别和体重指数相匹配的健康对照者进行比较。
身体成分测量（通过临床评估和双能X线吸收法（DEXA）扫描进行评估）以及血清脂肪细胞因子谱。
与匹配的对照者相比，CS长期缓解的患者腰围更大（P < 0.01），大腿围更小（P < 0.01），腰臀比更高（P < 0.01），髋大腿比更高（P < 0.01）。通过DEXA扫描测量，患者躯干脂肪量百分比更高（P = 0.01），躯干脂肪量与腿部脂肪量之比更大（P < 0.01）。与对照者相比，患者脂联素水平更低（P < 0.01），瘦素水平更高（P < 0.01），抵抗素水平更高（P = 0.04）。
即使经过长期缓解，既往患有CS的患者仍继续存在向心性脂肪组织分布和不良的脂肪细胞因子谱。这与CS的病因、治疗策略、激素缺乏和合并症无关，可能导致心血管风险持续增加。
