肢端肥大症患者的身体成分与能量消耗
Body composition and energy expenditure in acromegaly.
作者信息
O'Sullivan A J, Kelly J J, Hoffman D M, Freund J, Ho K K
机构信息
Garvan Institute of Medical Research, Department of Nuclear Medicine, St. Vincent's Hospital, Sydney, Australia.
出版信息
J Clin Endocrinol Metab. 1994 Feb;78(2):381-6. doi: 10.1210/jcem.78.2.8106626.
To investigate whether GH is a regulator of body composition and energy metabolism in adult life, we have compared body composition and resting energy expenditure (REE) in a cross-sectional study in 20 acromegalic and 20 normal subjects, pair-matched for sex, age, height, and weight. In a longitudinal study, 8 acromegalic patients were also studied before and after 12 weeks of treatment [n = 6 during octreotide (100 micrograms, 3 times/day); n = 2 after pituitary surgery], and 7 patients were studied 12 weeks after withdrawal of octreotide. REE was measured by indirect calorimetry and fat mass and fat-free soft tissue mass (FFSTM) by dual energy x-ray absorptiometry. A subgroup of 12 matched pairs of subjects and 7 treated patients had measurement of extracellular water (ECW) by 24Na dilution, which when subtracted from FFSTM provided an estimate of body cell mass (BCM). Fat mass was significantly reduced (25.4 +/- 2.2 vs. 29.7 +/- 2.7 kg; P = 0.007) and FFSTM increased (53.3 +/- 2.2 vs. 49.2 +/- 2.3 kg; P = 0.003) in acromegaly with ECW (25.6 +/- 1.6 vs. 21.1 +/- 0.9 L; P = 0.0003), but not BCM, significantly elevated. Treatment of acromegaly increased fat mass and reduced FFSTM [change (delta), -1.3 +/- 0.4 kg; P = 0.004]; the latter reflected a significant fall in ECW (delta, -2.2 +/- 0.4 L; P = 0.002), but not BCM. The opposite effect on body composition occurred after treatment withdrawal. REE was increased in acromegaly (1682 +/- 49 vs. 1540 +/- 45 Cal/24 h; P = 0.02) and significantly related to insulin-like growth factor-I (P = 0.02). REE was significantly reduced (delta, -154 +/- 17 Cal/24 h; P = 0.0001) with treatment and increased after treatment withdrawal (P = 0.003). In acromegaly, there is a reversible 1) reduction in fat mass; 2) increase in FFSTM, accounted for by an increase in ECW, but not BCM; and 3) increase in REE, which is dependent on disease activity. We conclude from these observations in acromegaly that GH is a regulator of energy metabolism and body composition.
为研究生长激素（GH）是否为成年期身体成分和能量代谢的调节因子，我们在一项横断面研究中比较了20例肢端肥大症患者和20例正常受试者的身体成分及静息能量消耗（REE），这些受试者在性别、年龄、身高和体重方面进行了配对。在一项纵向研究中，还对8例肢端肥大症患者在12周治疗前后进行了研究[n = 6接受奥曲肽治疗（100微克，每日3次）；n = 2接受垂体手术后]，并对7例患者在停用奥曲肽12周后进行了研究。REE通过间接测热法测量，脂肪量和去脂软组织量（FFSTM）通过双能X线吸收法测量。12对匹配的受试者和7例接受治疗的患者的一个亚组通过24Na稀释法测量细胞外液（ECW），从FFSTM中减去ECW可估算身体细胞量（BCM）。肢端肥大症患者的脂肪量显著减少（25.4±2.2 vs. 29.7±2.7 kg；P = 0.007），FFSTM增加（53.3±2.2 vs. 49.2±2.3 kg；P = 0.003），ECW显著升高（25.6±1.6 vs. 21.1±0.9 L；P = 0.0003），但BCM无显著变化。肢端肥大症的治疗使脂肪量增加，FFSTM减少[变化量（δ），-1.3±0.4 kg；P = 0.004]；后者反映ECW显著下降（δ，-2.2±0.4 L；P = 0.002），但BCM无变化。停药后对身体成分产生相反的影响。肢端肥大症患者的REE增加（1682±49 vs. 1540±45卡/24小时；P = 0.02），且与胰岛素样生长因子-I显著相关（P = 0.02）。治疗后REE显著降低（δ，-154±17卡/24小时；P = 0.0001），停药后增加（P = 0.003）。在肢端肥大症中，存在可逆的：1）脂肪量减少；2）FFSTM增加，这是由ECW增加而非BCM增加所致；3）REE增加，这取决于疾病活动度。我们从肢端肥大症的这些观察结果得出结论，GH是能量代谢和身体成分的调节因子。
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