Department of Internal Medicine, section of Endocrinology, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands.
Health Qual Life Outcomes. 2018 Jul 6;16(1):135. doi: 10.1186/s12955-018-0963-2.
The aim of the present study was to investigate the effect of low-normal and high-normal levels of IGF-1 in growth hormone (GH) deficient adults on cognition and wellbeing during GH treatment.
A randomized, open-label, clinical trial including 32 subjects receiving GH therapy for at least 1 year. Subjects were randomized to receive either a decrease (IGF-1 target level of - 2 to - 1 SDS) or an increase of their daily GH dose (IGF-1 target level of 1 to 2 SDS) for a period of 24 weeks. Memory was measured by the Cambridge Neuropsychological Test Automated Battery, selecting the Pattern Recognition Memory task and the Spatial Working Memory. Wellbeing was measured as mood by the Profile of Moods States questionnaire, and quality of life by the Nottingham Health Profile and QoL Assessment in GH Deficiency in Adults questionnaires.
Data from 30 subjects (65.6% male, mean age 46.6 (9.9 SD) years), who fulfilled the target levels, were analyzed. Females in the low dose treatment arm were found to have a better working memory and a better strategic memory control after 24 weeks as opposed to the females in the high treatment arm. With respect to mood, the decrease in IGF-1 levels in females within the low treatment arm was associated with more fatigue and less vigor.
The adjustment of GH dose in female patients seems to have a narrow window. A dose too high may impair prefrontal cognitive functioning, while a dose too low may result in decreased vigor.
This study is registered with ClinicalTrials.gov , number NCT01877512.
本研究旨在探讨生长激素（GH）缺乏症成人中 IGF-1 的低正常和高正常水平对 GH 治疗期间认知和健康的影响。
这是一项随机、开放标签、临床试验，纳入 32 名至少接受 1 年 GH 治疗的受试者。受试者被随机分为两组，一组接受 GH 剂量减少（IGF-1 目标水平为-2 至-1 SDS），另一组接受 GH 剂量增加（IGF-1 目标水平为 1 至 2 SDS），治疗期为 24 周。采用剑桥神经心理学测试自动电池测量记忆，选择模式识别记忆任务和空间工作记忆。使用心境状态问卷（Profile of Moods States questionnaire）测量健康状况，使用诺丁汉健康概况问卷和成人 GH 缺乏症生活质量评估问卷（Nottingham Health Profile and QoL Assessment in GH Deficiency in Adults questionnaires）测量生活质量。
对达到目标水平的 30 名受试者（65.6%为男性，平均年龄 46.6（9.9 SD）岁）的数据进行了分析。与高剂量治疗组的女性相比，低剂量治疗组的女性在 24 周后表现出更好的工作记忆和更好的策略记忆控制。在情绪方面，低剂量治疗组女性 IGF-1 水平下降与疲劳增加和活力降低有关。
女性患者 GH 剂量的调整似乎存在一个狭窄的窗口。剂量过高可能会损害前额叶认知功能，而剂量过低可能会导致活力下降。
本研究在 ClinicalTrials.gov 注册，编号为 NCT01877512。
