Erasmus University Medical Center, Department of Paediatrics, Subdivision of Endocrinology, Rotterdam, Netherlands.
Erasmus University Medical Center, Department of Paediatrics, Subdivision of Endocrinology, Rotterdam, Netherlands.
Lancet Diabetes Endocrinol. 2017 Dec;5(12):975-985. doi: 10.1016/S2213-8587(17)30311-X. Epub 2017 Nov 1.
Growth hormone treatment reduces blood pressure and lipid concentrations. We assessed long-term changes in blood pressure, lipid concentrations, and carotid intima media thickness over a 5-year period after cessation of growth hormone treatment in adults born small for gestational age.
We did a longitudinal observational study at a medical centre in the Netherlands between April 1, 2004, and April 1, 2016. We included adults born small for gestational age who were treated with growth hormone (1 mg/m per day); treatment started during childhood until adult height. Participants were evaluated at cessation of treatment, and 6 months, 2 years, and 5 years later. We compared cardiovascular risk factors with untreated controls from the PROGRAM study.
We included 199 participants born small for gestational age and treated with growth hormone along with 285 controls: 51 untreated short adults born small for gestational age, 92 untreated adults born small for gestational age with spontaneous catch-up growth, and 142 adults born appropriate for gestational age. In the 6 months after treatment cessation, systolic blood pressure increased temporarily from 113·00 mm Hg (95% CI 111·18-114·82) to 116·92 mm Hg (115·07 to 118·77; p<0·001) and diastolic blood pressure increased temporarily from 62·19 mm Hg (60·99-63·38) to 66·51 mm Hg (65·14-67·89; p<0·001). At 5 years after treatment cessation, mean systolic blood pressure was 109·2 mm Hg (105·5-113·0) and mean diastolic blood pressure was 63·4 mm Hg (60·9-65·9), similar to the values at cessation. Lipid concentrations were non-significantly higher 5 years after treatment cessation (p values 0·09-0·21) than at treatment cessation. Cessation of growth hormone had no effect on carotid intima media thickness. At 5 years after cessation, total cholesterol was lower in adults treated with growth hormone (mean 4·21 mmol/L, 95% CI 4·04-4·38) than in untreated short adults born small for gestational age (4·66 mmol/L, 4·42-4·92; p=0·0030), as was mean LDL cholesterol (2·28 mmol/L, 2·14-2·43 vs 2·85 mmol/L, 2·62-3·10; p<0·0001); blood pressure and carotid intima media thickness did not differ between these two groups (p values >0·12). At 5 years after cessation, systolic blood pressure, diastolic blood pressure, lipid concentrations, and carotid intima media thickness of adults treated with growth hormone were not different to those in adults born small for gestational age who had spontaneous catch-up growth or adults born appropriate for gestational age.
Long-term growth hormone treatment in children born small for gestational age has no unfavourable effects on cardiovascular health in early adulthood and improves lipid profiles.
Novo Nordisk (Netherlands).
生长激素治疗可降低血压和血脂浓度。我们评估了在出生时小于胎龄的成年人停止生长激素治疗后的 5 年内血压、血脂浓度和颈动脉内膜中层厚度的长期变化。
我们在荷兰的一家医疗中心进行了一项纵向观察性研究，时间为 2004 年 4 月 1 日至 2016 年 4 月 1 日。我们纳入了接受生长激素（每天 1 毫克/平方米）治疗的出生时小于胎龄的成年人；治疗开始于儿童期，直到成年身高。参与者在停止治疗时以及 6 个月、2 年和 5 年后进行评估。我们将心血管危险因素与 PROGRAM 研究中的未治疗对照组进行了比较。
我们纳入了 199 名接受生长激素治疗的出生时小于胎龄的成年人和 285 名对照者：51 名未接受治疗的出生时小于胎龄的短成年人、92 名未接受治疗的出生时小于胎龄且自然追赶生长的成年人和 142 名出生时胎龄正常的成年人。在治疗停止后的 6 个月内，收缩压暂时从 113.00mmHg（95%CI 111.18-114.82）增加到 116.92mmHg（115.07 至 118.77；p<0.001），舒张压也暂时从 62.19mmHg（60.99-63.38）增加到 66.51mmHg（65.14-67.89；p<0.001）。在治疗停止后的 5 年内，平均收缩压为 109.2mmHg（105.5-113.0），平均舒张压为 63.4mmHg（60.9-65.9），与停止治疗时相似。停止生长激素治疗 5 年后，血脂浓度略有升高（p 值为 0.09-0.21）。生长激素治疗对颈动脉内膜中层厚度没有影响。在停止治疗 5 年后，接受生长激素治疗的成年人的总胆固醇（平均 4.21mmol/L，95%CI 4.04-4.38）低于未接受治疗的出生时小于胎龄的短成年人（4.66mmol/L，4.42-4.92；p=0.0030），LDL 胆固醇的平均值也更低（2.28mmol/L，2.14-2.43 vs 2.85mmol/L，2.62-3.10；p<0.0001）；两组之间的血压和颈动脉内膜中层厚度没有差异（p 值>0.12）。在停止治疗后的 5 年内，接受生长激素治疗的成年人的收缩压、舒张压、血脂浓度和颈动脉内膜中层厚度与自然追赶生长或胎龄正常的成年人没有差异。
在儿童时期长期生长激素治疗对成年早期的心血管健康没有不良影响，并改善了血脂谱。
诺和诺德（荷兰）。
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