Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Yale School of Medicine, New Haven, CT, USA.
Clin Endocrinol (Oxf). 2021 Feb;94(2):183-192. doi: 10.1111/cen.14344. Epub 2020 Oct 10.
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in young adults with obesity. Obesity is associated with relative growth hormone (GH) deficiency, and data from animal studies and from humans with pituitary GH deficiency suggest a role for GH deficiency in the pathogenesis of NAFLD. The effects of GH on NAFLD in those with obesity are unknown, however, prompting this pilot study to assess effects of GH administration on measures of NAFLD in young adults.
Twenty-four men and women aged 18-29 years with BMI ≥ 30 kg/m , hepatic fat fraction (HFF) ≥ 5% on proton magnetic resonance spectroscopy ( H-MRS) and insulin-like growth factor 1 (IGF-1) z-score ≤ 0 were randomized to treatment with recombinant human GH (rhGH) versus no treatment for 24 weeks. The primary endpoint was change in HFF.
Compared to no treatment, the effect size of rhGH on absolute HFF over 24 weeks was -3.3% (95% confidence interval: -7.8%, 1.2%; p = .14). At 24 weeks, HFF < 5% was achieved in 5 of 9 individuals receiving rhGH versus 1 of 9 individuals receiving no treatment (p = .04). rhGH did not significantly reduce ALT, AST or GGT. Serum IGF-1 increased as expected with rhGH treatment, and there were no changes in fasting lipids, C-reactive protein, fasting glucose or 2-h glucose following an oral glucose tolerance test.
Data from this pilot study suggest that rhGH treatment in young adults with obesity and NAFLD may have benefits to reduce liver fat content, although larger studies are needed to confirm this effect.
非酒精性脂肪性肝病(NAFLD)在肥胖的年轻成年人中非常普遍。肥胖与相对生长激素(GH)缺乏有关,动物研究和生长激素缺乏的人类的数据表明 GH 缺乏在 NAFLD 的发病机制中起作用。然而,肥胖者中 GH 对 NAFLD 的影响尚不清楚,这促使本研究评估 GH 给药对年轻成年人 NAFLD 指标的影响。
24 名年龄在 18-29 岁之间、BMI≥30kg/m 、质子磁共振波谱( H-MRS)上肝脂肪分数(HFF)≥5%且胰岛素样生长因子 1(IGF-1)z 分数≤0 的男性和女性被随机分为接受重组人生长激素(rhGH)治疗组和不治疗组,治疗时间为 24 周。主要终点是 HFF 的变化。
与不治疗相比,rhGH 对 24 周时绝对 HFF 的影响大小为-3.3%(95%置信区间:-7.8%,1.2%;p=0.14)。在 24 周时,接受 rhGH 治疗的 9 名患者中有 5 名患者的 HFF<5%,而接受不治疗的 9 名患者中有 1 名患者的 HFF<5%(p=0.04)。rhGH 治疗并未显著降低 ALT、AST 或 GGT。rhGH 治疗后血清 IGF-1 升高,口服葡萄糖耐量试验后空腹血脂、C 反应蛋白、空腹血糖或 2 小时血糖无变化。
这项初步研究的数据表明,rhGH 治疗肥胖和 NAFLD 的年轻成年人可能有益于降低肝脂肪含量,尽管需要更大的研究来证实这一效果。