Bengtsson B A, Edén S, Lönn L, Kvist H, Stokland A, Lindstedt G, Bosaeus I, Tölli J, Sjöström L, Isaksson O G
Department of Medicine, Sahlgrenska Hospital, Medical Faculty, University of Goteborg, Sweden.
J Clin Endocrinol Metab. 1993 Feb;76(2):309-17. doi: 10.1210/jcem.76.2.8432773.
In a double blind, cross-over placebo-controlled trial, we studied the effects of 26 weeks of replacement therapy with recombinant human GH on body composition, metabolic parameters, and well-being in 10 patients with adult-onset GH deficiency (GHD). All patients received appropriate thyroid, adrenal, and gonadal replacement therapy. The dose of recombinant human GH was 0.25-0.5 U/kg.week (0.013-0.026 mg/kg.day) and was administered sc daily at bedtime. One patient was withdrawn from the study because of edema and atrial fibrillation. Body composition was estimated with three independent methods: computed tomography, bioelectric impedance, and total body potassium combined with total body water assessments. The Comprehensive Psychological Rating Scale and the Symptom Check List-90 were used to assess any change in psychopathology. After 26 weeks of treatment, adipose tissue (AT) mass decreased 4.7 kg (P < 0.001). Subcutaneous AT decreased by an average of 13%, whereas visceral AT was reduced by 30%. Muscle volume increased by 2.5 kg (5%; P < 0.05). According to the four-compartment model derived from assessments of total body potassium and total body water, body cell mass and extracellular fluid volume increased significantly by 1.6 and 3.0 kg, whereas body fat decreased by 6.1 kg. Results obtained by the bioelectric impedance technique were similar. The mean (+/- SD) concentrations of insulin-like growth factor-I increased from 0.26 (0.06) at baseline to 2.56 (1.55) and 2.09 (1.03) kU/L after 6 and 26 weeks of treatment. Calcium and serum phosphate, osteocalcin, and procollagen-III concentrations were significantly higher, and intact PTH concentrations were reduced after 6 and 26 weeks of treatment, respectively. Total and free T3 concentrations were significantly increased after 6 and 26 weeks of treatment, whereas free T4 concentrations were reduced at 6 weeks, but after 26 weeks, free T4 concentrations had returned to pretreatment values. Finally, after 26 weeks of treatment, there was a decrease in the Comprehensive Psychological Rating Scale score (P < 0.05). The results show that GH replacement in GHD adults results in marked alterations in body composition, fat distribution, and bone and mineral metabolism and reduces psychiatric symptoms. Finally, we conclude that the observed beneficial effects of replacement therapy with GH are of sufficient magnitude to consider treatment of GHD adults.
在一项双盲、交叉、安慰剂对照试验中，我们研究了重组人生长激素（GH）替代治疗26周对10例成人起病的生长激素缺乏症（GHD）患者身体成分、代谢参数和幸福感的影响。所有患者均接受了适当的甲状腺、肾上腺和性腺替代治疗。重组人生长激素的剂量为0.25 - 0.5 U/kg·周（0.013 - 0.026 mg/kg·天），每天睡前皮下注射。1例患者因水肿和心房颤动退出研究。采用三种独立方法评估身体成分：计算机断层扫描、生物电阻抗以及结合总体水评估的全身钾含量测定。使用综合心理评定量表和症状自评量表90来评估精神病理学方面的任何变化。治疗26周后，脂肪组织（AT）量减少4.7 kg（P < 0.001）。皮下AT平均减少13%，而内脏AT减少30%。肌肉量增加2.5 kg（5%；P < 0.05）。根据通过评估全身钾和总体水得出的四室模型，身体细胞量和细胞外液量显著增加，分别增加了1.6 kg和3.0 kg，而体脂减少了6.1 kg。生物电阻抗技术获得的结果相似。胰岛素样生长因子-I的平均（±标准差）浓度从基线时的0.26（0.06）在治疗6周和26周后分别升至2.56（1.55）和2.09（1.03）kU/L。钙、血清磷酸盐、骨钙素和前胶原III浓度在治疗6周和26周后分别显著升高，而完整甲状旁腺激素浓度降低。总T3和游离T3浓度在治疗6周和26周后显著升高，而游离T4浓度在6周时降低，但在26周后，游离T4浓度恢复到治疗前水平。最后，治疗26周后，综合心理评定量表评分降低（P < 0.05）。结果表明，对成人GHD患者进行GH替代治疗会导致身体成分、脂肪分布、骨和矿物质代谢发生显著改变，并减轻精神症状。最后，我们得出结论，观察到的GH替代治疗的有益效果程度足以考虑对成人GHD患者进行治疗。
