Department of Pediatrics, University "Federico II" of Naples, Naples, Italy.
Department of Translational Medical Sciences Pediatric Endocrinology Section, University "Federico II" of Naples, Naples, Italy.
Endocrine. 2018 Mar;59(3):643-650. doi: 10.1007/s12020-017-1408-0. Epub 2017 Sep 5.
To evaluate glucose homeostasis in children with growth hormone (GH) deficiency (GHD) receiving long-term replacement therapy.
We evaluated glucose, insulin, HOmeostasis Model Assessment (HOMA-IR), and HbA1c in 100 GHD children at diagnosis and during 5 years of therapy. One hundred healthy children comparable to patients were evaluated at baseline and after 1 and 5 years.
No difference was detected at baseline between GHD patients and controls in glucose (79.58 ± 9.96 vs. 77.18 ± 8.20 mg/dl), insulin (4.50 ± 3.24 vs. 4.30 ± 2.60 µU/ml), HbA1c (5.20 ± 0.31 vs. 5.25 ± 0.33%) levels, and HOMA-IR (0.93 ± 0.72 vs. 0.86 ± 0.61). One year of GH was associated with a significant increase in insulin (7.21 ± 4.84, p < 0.001) and HOMA-IR (1.32 ± 0.98, p < 0.001) in GHD children, which became different from controls (p < 0.001 and p = 0.004). These parameters did not change further during the following years of treatment in GHD subjects. In contrast, controls did not show significant changes in insulin (4.40 ± 2.60) and HOMA-IR (0.82 ± 0.60) during the first year; however, at the fifth year of the study a significant increase in insulin (6.50 ± 3.50, p = 0.004) and HOMA-IR (1.29 ± 0.54, p < 0.001) was documented, making these parameters comparable between patients and controls.
Our results suggest that growth hormone (GH) treatment is not associated with significant impairment of insulin sensitivity in GHD children. The slight impairment observed in GHD adolescents after long-term GH is comparable to that physiologically occurring in healthy pubertal subjects.
评估接受长期替代治疗的生长激素缺乏症（GHD）儿童的葡萄糖稳态。
我们评估了 100 名 GHD 儿童在诊断时和 5 年治疗期间的葡萄糖、胰岛素、稳态模型评估（HOMA-IR）和糖化血红蛋白（HbA1c）。100 名与患者可比的健康儿童在基线和 1 年和 5 年后进行了评估。
GHD 患者和对照组在葡萄糖（79.58±9.96 vs. 77.18±8.20mg/dl）、胰岛素（4.50±3.24 vs. 4.30±2.60µU/ml）、HbA1c（5.20±0.31 vs. 5.25±0.33%）和 HOMA-IR（0.93±0.72 vs. 0.86±0.61）水平方面，在基线时无差异。接受 GH 治疗 1 年后，GHD 儿童的胰岛素（7.21±4.84，p<0.001）和 HOMA-IR（1.32±0.98，p<0.001）显著增加，与对照组不同（p<0.001 和 p=0.004）。在 GHD 受试者随后的治疗年中，这些参数没有进一步变化。相比之下，对照组在第一年中胰岛素（4.40±2.60）和 HOMA-IR（0.82±0.60）没有明显变化；然而，在研究的第五年，胰岛素（6.50±3.50，p=0.004）和 HOMA-IR（1.29±0.54，p<0.001）显著增加，使这些参数在患者和对照组之间具有可比性。
我们的结果表明，生长激素（GH）治疗与 GHD 儿童的胰岛素敏感性显著受损无关。在长期 GH 治疗后，GHD 青少年观察到的轻微损伤与健康青春期受试者中生理性发生的损伤相当。
