al-Shoumer K A, Gray R, Anyaoku V, Hughes C, Beshyah S, Richmond W, Johnston D G
Unit of Endocrinology and Metabolic Medicine, Imperial College School of Medicine, St Mary's Hospital, London, UK.
Clin Endocrinol (Oxf). 1998 Jun;48(6):795-802. doi: 10.1046/j.1365-2265.1998.00460.x.
To study the effects of long-term growth hormone (GH) treatment on lipid metabolism and carbohydrate tolerance in GH-deficient adults.
Open trial of GH treatment for 4 years. GH dose was (median, range) 0.025 (0.010-0.050) IU/kg daily.
Thirteen GH-deficient hypopituitary adults (seven men, six women), aged (median, range) 47 (24-65) years were followed for 4 years.
Fasting lipids, lipoproteins, apolipoproteins, glucose and insulin concentrations were measured at yearly intervals during GH therapy. A 75-g oral glucose tolerance test (OGTT) was also performed yearly, during which circulating glucose and insulin were measured at 30-minute intervals for 3 h.
Fasting total and low density lipoprotein (LDL) cholesterol concentrations decreased on GH therapy, but no change was observed in fasting triglyceride or high density lipoprotein (HDL) concentrations. Compared to pretreatment values, total and LDL cholesterol levels were significantly lower at 1 year (mean +/- SEM) (6.39 +/- 0.46 vs. 5.71 +/- 0.38 mmol/l, P < 0.05; 4.46 +/- 0.36 vs. 3.24 +/- 0.20 mmol/l, P < 0.01, respectively) and the reductions were maintained for the 4 years. Apolipoproteins A-1 and B did not differ significantly from the pretreatment levels. Fasting plasma glucose increased significantly at the first year (4.9 +/- 0.1 vs. 5.3 +/- 0.1 mmol/l, P < 0.05) but it returned to the pretreatment value in the following years. Fasting plasma insulin increased significantly at 1 year (4.3 (1.0-13.6) vs. 11.9 (1.2-26.9) mU/l, P < 0.05) and showed a progressive downward trend but remained significantly raised throughout the subsequent years. The 3-h area under the glucose curve (AUC) during the OGTT tended to be increased at the first year (P = 0.07) and it returned to the pretreatment level in the following years. The AUC of plasma insulin was significantly raised at 1 year (P = 0.024) and it returned to the pretreatment level in the following years.
Four years of GH therapy in GH-deficient adults resulted in a sustained improvement in total and LDL cholesterol concentrations. Mild fasting hyperinsulinaemia persisted, although an initial deterioration in glucose tolerance, associated with post-glucose hyperinsulinaemia, was not sustained.
研究长期生长激素（GH）治疗对生长激素缺乏的成年人脂质代谢和糖耐量的影响。
GH治疗4年的开放试验。GH剂量为（中位数，范围）每日0.025（0.010 - 0.050）IU/kg。
13名生长激素缺乏的垂体功能减退成年人（7名男性，6名女性），年龄（中位数，范围）47（24 - 65）岁，随访4年。
在GH治疗期间每年测量空腹血脂、脂蛋白、载脂蛋白、葡萄糖和胰岛素浓度。每年还进行一次75g口服葡萄糖耐量试验（OGTT），在此期间，每隔30分钟测量一次循环葡萄糖和胰岛素，共测量3小时。
GH治疗期间空腹总胆固醇和低密度脂蛋白（LDL）胆固醇浓度降低，但空腹甘油三酯或高密度脂蛋白（HDL）浓度未见变化。与治疗前值相比，1年时总胆固醇和LDL胆固醇水平显著降低（均值±标准误）（分别为6.39±0.46 vs. 5.71±0.38 mmol/l，P < 0.05；4.46±0.36 vs. 3.24±0.20 mmol/l，P < 0.01），且在4年中持续降低。载脂蛋白A - 1和B与治疗前水平无显著差异。空腹血糖在第1年显著升高（4.9±0.1 vs. 5.3±0.1 mmol/l，P < 0.05），但在随后几年恢复到治疗前值。空腹血浆胰岛素在1年时显著升高（4.3（1.0 - 13.6）vs. 11.9（1.2 - 26.9）mU/l，P < 0.05），并呈逐渐下降趋势，但在随后几年仍显著升高。OGTT期间葡萄糖曲线下3小时面积（AUC）在第1年有升高趋势（P = 0.07），随后几年恢复到治疗前水平。血浆胰岛素AUC在1年时显著升高（P = 0.024），随后几年恢复到治疗前水平。
生长激素缺乏的成年人接受4年GH治疗可使总胆固醇和LDL胆固醇浓度持续改善。尽管最初与葡萄糖后高胰岛素血症相关的糖耐量恶化未持续，但轻度空腹高胰岛素血症持续存在。
