Appelman-Dijkstra Natasha M, Rijndorp Marnick, Biermasz Nienke R, Dekkers Olaf M, Pereira Alberto M
Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Endocrinol. 2016 Jun;174(6):705-16. doi: 10.1530/EJE-15-1086. Epub 2016 Mar 4.
Recombinant human growth hormone (rhGH) replacement is advocated in adult growth hormone-deficient (GHD) patients to increase bone mass and improve lipid profile, body composition, and quality of life. The long-term effects of discontinuation of rhGh replacement are unknown.
This cohort study and systematic review aim to evaluate the long-term metabolic effects of discontinuation of rhGh replacement in adult GHD patients, with a subgroup analyses according to age (< or > 60 years). Data on anthropometry, lipids, glucose, and bone mass density (BMD) were assessed for 3 years after discontinuation.
Cohort study included 64 patients who had discontinued rhGh replacement for >12 months. Fat percentage increased from 31.5±9.5% to 33.8±9.0% (mean difference 2.3, P=0.003). BMI decreased only in subjects <60 years (P=0.014). Glucose, total cholesterol, and LDL-cholesterol levels did not change; however, the percentage of patients on statins increased slightly from 39% to 44%. HDL-C concentration increased only in patients <60 years (mean difference 0.2, P=0.043). Lumbar spine BMD did not change; however, femoral neck BMD and bone turnover markers decreased in subjects <60 years (P=0.001). Systematic review included eight studies (n=166 patients) with a follow-up duration of 6-18 months. Of the Please check the edit of the sentence 'Of the eight studies "'.eight studies, three qualified as low risk of bias and five as having an intermediate risk of bias. None of the studies reported handling of statins, bisphosphonates, and glucose-lowering medication or excluded patients using these medications.
In this study, discontinuation of rhGh replacement resulted in metabolic changes only in patients <60 years after 3 years. Further research warrants to determine the optimal strategies for (dis)continuation of rhGh replacement in adult patients with GHD.
对于成年生长激素缺乏症（GHD）患者，提倡使用重组人生长激素（rhGH）替代疗法来增加骨量，并改善血脂状况、身体成分和生活质量。rhGH替代疗法中断后的长期影响尚不清楚。
这项队列研究和系统评价旨在评估成年GHD患者中断rhGH替代疗法后的长期代谢影响，并根据年龄（<或>60岁）进行亚组分析。在中断治疗后3年评估人体测量学、血脂、血糖和骨密度（BMD）数据。
队列研究纳入了64例中断rhGH替代疗法超过12个月的患者。脂肪百分比从31.5±9.5%增加到33.8±9.0%（平均差异2.3，P = 0.003）。仅<60岁的受试者BMI下降（P = 0.014）。血糖、总胆固醇和低密度脂蛋白胆固醇水平没有变化；然而，服用他汀类药物的患者比例从39%略有增加到44%。仅<60岁的患者高密度脂蛋白胆固醇浓度升高（平均差异0.2，P = 0.043）。腰椎骨密度没有变化；然而，<60岁的受试者股骨颈骨密度和骨转换标志物下降（P = 0.001）。系统评价纳入了八项研究（n = 166例患者），随访时间为6 - 18个月。八项研究中，三项被判定为低偏倚风险，五项为中等偏倚风险。没有研究报告他汀类药物、双膦酸盐和降糖药物的使用情况，也没有排除使用这些药物的患者。
在本研究中，rhGH替代疗法中断仅在3年后导致<60岁的患者出现代谢变化。需要进一步研究以确定成年GHD患者rhGH替代疗法（停/用）的最佳策略。
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