Burman P, Johansson A G, Siegbahn A, Vessby B, Karlsson F A
Department of Medicine, Clinical Chemistry, University Hospital, Uppsala, Sweden.
J Clin Endocrinol Metab. 1997 Feb;82(2):550-5. doi: 10.1210/jcem.82.2.3776.
Thirty-six patients with adult-onset GH deficiency (GHD) were examined before and after 9 months of treatment with recombinant GH. The study was conducted as a double blind, placebo-controlled, 21-month trial with a cross-over design, with each treatment period lasting for 9 months. The same dose, adjusted for body surface area, was given to men (n = 21) and women (n = 15), and the effects on body composition and biochemical parameters were evaluated with respect to gender. The extent of GHD, assessed before therapy from basal GH secretion and GH release in response to provocative tests, did not differ between the two groups. The men, however, had higher serum insulin-like growth factor I concentrations than the women (mean +/- SD, 126 +/- 71 vs. 61 +/- 32 micrograms/L; P = 0.0003), less body fat, and greater lean body mass. Upon treatment, insulin-like growth factor I concentrations increased more in men than in women (by 305 +/- 136 and 198 +/- 96 micrograms/L, respectively; P = 0.02). The men lost more body fat than the women (7.4 +/- 4.1% vs. 3.3 +/- 3.8%; P = 0.002), whereas the difference in gain in lean body mass failed to reach statistical significance. Serum levels of total cholesterol, low density lipoprotein cholesterol, apolipoprotein B, and plasminogen activator inhibitor-1 decreased in the male group (P = 0.003, P = 0.03, P = 0.0009, and P = 0.01, respectively), but not in the females. Serum markers of bone formation, namely osteocalcin, procollagen type I, bone-specific alkaline phosphatase, and a marker of bone resorption, telopeptide of collagen type I, increased more markedly in men than in women. Lipoprotein(a) increased to a similar extent in the male and female groups. The data demonstrate that men and women with GHD display marked differences in their responsiveness to GH replacement therapy. These differences should be taken into consideration when optimizing the treatment of GHD patients.
36例成年起病的生长激素缺乏症（GHD）患者在接受重组生长激素治疗9个月前后接受了检查。该研究采用双盲、安慰剂对照、为期21个月的交叉设计试验，每个治疗期持续9个月。根据体表面积调整后的相同剂量给予男性（n = 21）和女性（n = 15），并针对性别评估对身体成分和生化参数的影响。治疗前根据基础生长激素分泌和对激发试验的生长激素释放评估的GHD程度在两组之间无差异。然而，男性的血清胰岛素样生长因子I浓度高于女性（均值±标准差，126±71 vs. 61±32μg/L；P = 0.0003），体脂较少，瘦体重较大。治疗后，男性的胰岛素样生长因子I浓度升高幅度大于女性（分别升高305±136和198±96μg/L；P = 0.02）。男性比女性减掉更多的体脂（7.4±4.1% vs. 3.3±3.8%；P = 0.002），而瘦体重增加的差异未达到统计学意义。男性组的总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B和纤溶酶原激活物抑制剂-1血清水平下降（分别为P = 0.003、P = 0.03、P = 0.0009和P = 0.01），但女性组未下降。骨形成的血清标志物，即骨钙素、I型前胶原、骨特异性碱性磷酸酶，以及骨吸收标志物I型胶原端肽，男性升高比女性更明显。男性和女性组中脂蛋白(a)升高程度相似。数据表明，患有GHD的男性和女性对生长激素替代疗法的反应存在显著差异。在优化GHD患者的治疗时应考虑这些差异。
