Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Via Pietro Giardini 1355, 41126, Modena, Italy.
Eli Lilly, Sesto Fiorentino, Italy.
J Endocrinol Invest. 2018 Nov;41(11):1259-1266. doi: 10.1007/s40618-018-0860-x. Epub 2018 Mar 13.
To examine differences in effects according to growth hormone (GH) treatment duration in adult GH-deficient patients.
In the Italian cohort of the observational Hypopituitary Control and Complications Study, GH-treated adults with GH deficiency (GHD) were grouped by duration of treatment; ≤ 2 years (n = 451), > 2 to ≤ 6 years (n = 387) and > 6 years (n = 395). Between-group differences in demographics, medical history, physical characteristics, insulin-like growth factor-I standard deviation score (IGF-I SDS) and lipid profile at baseline, last study visit and changes from baseline to last study visit were assessed overall, for adult- and childhood-onset GHD and by gender using ANOVA for continuous variables and Chi-squared test for categorical variables.
At baseline, treatment duration groups did not differ significantly for age, gender, body mass index, GHD onset, IGF-I SDS, lipid profile, and quality of life. Mean initial GH dose did not differ significantly according to treatment duration group in any subgroup, except female patients, with highest mean dose seen in the longest duration group. In the longest duration group for patients overall, adult-onset patients and male patients, there were significant decreases in GH dose from baseline to last visit, and in total and low-density lipoprotein (LDL)-cholesterol concentrations. IGF-I SDS increased, to a greater extent, in the longest duration group for patients overall and female patients.
The results show that long-term GH treatment is associated with decreasing GH dose, increased IGF-I, decreased LDL-cholesterol and the presence of surrogate markers that help to give confidence in a diagnosis of GHD.
研究成人生长激素缺乏症(GHD)患者接受生长激素(GH)治疗的时间长短对疗效的影响。
在意大利垂体激素缺乏症控制和并发症研究的观察队列中,根据治疗时间长短将接受 GH 治疗的成人 GHD 患者分为三组:≤2 年(n=451)、>2 年至≤6 年(n=387)和>6 年(n=395)。采用方差分析(ANOVA)评估组间基线、末次随访和从基线到末次随访的变化时的人口统计学、病史、身体特征、胰岛素样生长因子-I 标准差评分(IGF-I SDS)和血脂谱的差异,采用卡方检验评估分类变量的差异。所有分析均为总体分析及成人和儿童起病的 GHD 亚组分析和性别亚组分析。
基线时,治疗时间组在年龄、性别、体重指数、GHD 发病年龄、IGF-I SDS、血脂谱和生活质量方面无显著差异。除女性患者外,各组间初始 GH 剂量无显著差异,而女性患者中最长治疗时间组的平均初始 GH 剂量最高。在所有患者、成人起病患者和男性患者中,最长治疗时间组从基线到末次随访时 GH 剂量、总胆固醇和低密度脂蛋白(LDL)-胆固醇浓度均显著降低。IGF-I SDS 在最长治疗时间组中的增长幅度更大,在所有患者和女性患者中更为显著。
这些结果表明,长期 GH 治疗与 GH 剂量减少、IGF-I 增加、LDL-胆固醇降低以及有助于确认 GHD 诊断的替代标志物的出现有关。