Holmes S J, Whitehouse R W, Swindell R, Economou G, Adams J E, Shalet S M
Department of Endocrinology, Christie Hospital NHS Trust, Manchester, UK.
Clin Endocrinol (Oxf). 1995 Jun;42(6):627-33. doi: 10.1111/j.1365-2265.1995.tb02690.x.
Previous studies of the effect of GH replacement on bone mass in adults with GH deficiency have produced conflicting results. We have studied the effect of 6 and 12 months of GH replacement on bone mass in adults with adult onset GH deficiency.
Double blind placebo controlled study of GH replacement (0.125 IU/kg/week for the first month and 0.25 IU/kg/week thereafter) for 6 months and an open study for a further 6 or 12 months.
Twenty-two adults (10 men, 12 women), aged 41.5 +/- 2.1 years (mean +/- SE, range 23.6-59.5), with adult onset GH deficiency.
Single-energy quantitative computed tomography was used to measure vertebral trabecular bone mineral density (BMD), single-photon absorptiometry (SPA) was used to measure forearm cortical and integral bone mineral content and BMD and dual-energy X-ray absorptiometry (DXA) was used to measure lumbar spine, femoral neck, trochanteric and Ward's triangle integral BMD.
After 6 months of GH replacement (n = 21) there was a significant decrease in forearm cortical BMD (SPA: median change -0.009 g/cm2, P = 0.01), forearm integral BMD (SPA: median change -0.016 g/cm2, P = 0.03), lumbar spine BMD (DXA: median change -0.22 g/cm2; P = 0.003) and femoral neck BMD (DXA: median change -0.029 g/cm2, P = 0.006). After 12 months of GH replacement (n = 13) there was a significant decrease in lumbar spine BMD (DXA: median change -0.035 g/cm2, P = 0.002) from baseline. There was no significant increase in bone mass at any site after 6 or 12 months of GH replacement. Change in bone mass was not influenced by sex of the patient or by presence or absence of additional pituitary hormone deficiencies.
The response of bone mass to 6 and 12 months of GH replacement in adults with adult onset GH deficiency is disappointing. Longer-term studies are required to determine whether prolonged GH replacement has a beneficial effect on bone mass.
既往关于生长激素（GH）替代治疗对成人生长激素缺乏症患者骨量影响的研究结果相互矛盾。我们研究了6个月和12个月的GH替代治疗对成人迟发性生长激素缺乏症患者骨量的影响。
GH替代治疗（第1个月0.125IU/kg/周，之后0.25IU/kg/周）的双盲安慰剂对照研究为期6个月，随后进行6个月或12个月的开放研究。
22例成人（10例男性，12例女性），年龄41.5±2.1岁（均值±标准误，范围23.6 - 59.5岁），患有成人迟发性生长激素缺乏症。
采用单能定量计算机断层扫描测量椎体小梁骨矿物质密度（BMD），采用单光子吸收测定法（SPA）测量前臂皮质骨和整体骨矿物质含量及BMD，采用双能X线吸收测定法（DXA）测量腰椎、股骨颈、大转子和Ward三角区的整体BMD。
GH替代治疗6个月后（n = 21），前臂皮质骨BMD（SPA：中位数变化 -0.009g/cm²，P = 0.01）、前臂整体BMD（SPA：中位数变化 -0.016g/cm²，P = 0.03）、腰椎BMD（DXA：中位数变化 -0.22g/cm²；P = 0.003）和股骨颈BMD（DXA：中位数变化 -0.029g/cm²，P = 0.006）均显著下降。GH替代治疗12个月后（n = 13），腰椎BMD较基线水平显著下降（DXA：中位数变化 -0.035g/cm²，P = 0.002）。GH替代治疗6个月或12个月后，任何部位的骨量均未显著增加。骨量变化不受患者性别或是否存在其他垂体激素缺乏的影响。
成人迟发性生长激素缺乏症患者接受6个月和12个月的GH替代治疗后，骨量反应令人失望。需要进行长期研究以确定延长GH替代治疗是否对骨量有有益影响。
