Boot A M, Engels M A, Boerma G J, Krenning E P, De Muinck Keizer-Schrama S M
Department of Pediatrics, Sophia Children's Hospital, Rotterdam, the Netherlands.
J Clin Endocrinol Metab. 1997 Aug;82(8):2423-8. doi: 10.1210/jcem.82.8.4149.
Adults with childhood onset GH deficiency (GHD) have reduced bone mass, increased fat mass, and disorders of lipid metabolism. The aim of the present study was to evaluate bone mineral density (BMD), bone metabolism, body composition, and lipid metabolism in GHD children before and during 2-3 yr of GH treatment (GHRx). Forty children with GHD, mean age 7.9 yr, participated in the study of bone metabolism and body composition; and an additional group of 17 GHD children, in the study of lipid metabolism. Lumbar spine BMD, total body BMD, and body composition were measured with dual-energy x-ray absorptiometry. Volumetric BMD (bone mineral apparent density, BMAD) was calculated to correct for bone size. BMD, BMAD, lean tissue mass, bone mineral content, fat mass, and percentage body fat were expressed as SD scores (SDS), in comparison with normative data of the same population. Lumbar spine BMD and BMAD and total body BMD were all decreased at baseline. All BMD variables increased significantly during GHRx, lumbar spine BMD SDS, already after 6 months of treatment. Lean tissue mass SDS increased continuously. Bone mineral content SDS started to increase after 6 months GHRx. Fat mass SDS decreased during the first 6 months of GHRx and remained stable thereafter. Biochemical parameters of bone formation and bone resorption did not differ from normal at baseline and increased during the first 6 months of GHRx. Serum 1,25 dihydroxyvitamin D increased continuously during GHRx, whereas PTH and serum calcium remained stable. Lipid profile was normal at baseline: Atherogenic index had decreased and apolipoprotein A1(Apo-A1) had increased after 3 yr of treatment. In conclusion, children with GHD have decreased bone mass. BMD, together with height and lean tissue mass, increased during GHRx. GHRx had a beneficial effect on lipid metabolism.
患有儿童期起病的生长激素缺乏症（GHD）的成年人骨量减少、脂肪量增加且存在脂质代谢紊乱。本研究的目的是评估GHD儿童在接受生长激素治疗（GHRx）2 - 3年之前及期间的骨矿物质密度（BMD）、骨代谢、身体成分和脂质代谢。40名平均年龄为7.9岁的GHD儿童参与了骨代谢和身体成分研究；另有17名GHD儿童参与了脂质代谢研究。采用双能X线吸收法测量腰椎BMD、全身BMD和身体成分。计算体积BMD（骨矿物质表观密度，BMAD）以校正骨大小。与同人群的标准数据相比，BMD、BMAD、瘦组织质量、骨矿物质含量、脂肪量和体脂百分比均以标准差分数（SDS）表示。基线时腰椎BMD、BMAD和全身BMD均降低。在GHRx期间，所有BMD变量均显著增加，腰椎BMD SDS在治疗6个月后即已增加。瘦组织质量SDS持续增加。骨矿物质含量SDS在GHRx 6个月后开始增加。脂肪量SDS在GHRx的前6个月下降，此后保持稳定。骨形成和骨吸收的生化参数在基线时与正常无异，在GHRx的前6个月增加。血清1,25 - 二羟维生素D在GHRx期间持续增加，而甲状旁腺激素（PTH）和血清钙保持稳定。脂质谱在基线时正常：治疗3年后致动脉粥样硬化指数降低，载脂蛋白A1（Apo - A1）增加。总之，GHD儿童骨量减少。在GHRx期间，BMD连同身高和瘦组织质量均增加。GHRx对脂质代谢有有益作用。
