Assessment of growth hormone dynamics in human immunodeficiency virus-related lipodystrophy
Assessment of growth hormone dynamics in human immunodeficiency virus-related lipodystrophy
复制标题
DOI：
10.1210/jc.86.2.504
复制
发表时间：
2001-02-01
影响因子：
5.8
通讯作者：
Grinspoon, S
中科院分区：
文献类型：
--
作者：
Rietschel, P;Hadigan, C;Grinspoon, S
人类免疫缺陷病毒（HIV）脂肪代谢障碍（LIPO）的特征是内脏脂肪增多、外周脂肪萎缩、血脂异常和胰岛素抵抗。已知GH浓度与超重和体脂成反比，但尚未在HIV脂肪代谢障碍中进行研究。本研究前瞻性地招募了21名HIV LIPO患者、20名HIV感染的非脂肪代谢障碍患者（NONLIPO）和20名对照（C）受试者，并进行了比较（四分位数范围，37-50）LIPO; 41（37-44）NONLIPO;和43（37-49）C]，体重指数匹配[中位数，24.3 kg/m2]（四分位距，22.2-26.6）LIPO; 24.4（23.3-25.9）NONLIPO;和24.8（22.7-26.1）C]（所有比较P > 0.05）。内脏腹部脂肪[16，124 mm（2）（11，246-19，790）LIPO; 7，559（5，134 - 11，201）NONLIPO;和8，803（6，165 - 11，623）C; P < 0.01 LIFO vs. NONLIPO和LIFO vs. C]和内脏腹部脂肪与皮下腹部脂肪的比值[1.37（0.71-2.44）LIPO vs. 0.57（0.47-0.78）NONLIPO vs. 0.55（0.41-0.71）C，P < 0.01 LIPO vs. NONLIPO和LIPO vs. C]在LIPO受试者中显著增加，但NONLIPO和C之间无显著差异。LIFO受试者的平均过夜GH浓度（从2000 h到0800 h每20 min频繁采样测定）降低[LIFO为0.38 mug/L（0.13-0.67）vs. 0.96（0.53-1.30）NONLIPO。0.81（0.49-1.03）C，P < 0.05 LIFO vs. NONLIPO和LIFO vs. C]，NONLIPO和C之间无显著差异。脉搏分析显示基线GH降低[0.08 g/L（0.06-0.21）LIPO对比0.19（0.10-0.32）非脂质体与0.17（0.12-0.57）C，P < 0.05 LIFO vs. NONLIPO和LIFO vs. C]和GH峰值振幅[1.06 g/L（0.46-1.94）LIFO与2.47（1.22-3.43）NONLIPO和2.27（1.36-4.25）C，P < 0.05 LIPO与NONLIPO和LIFO与C]，但脉搏频率无显著差异。在NONLIPO和C组之间未观察到任何GH参数的显著差异。胰岛素样生长因子-I在两组之间没有差异。HIV感染患者的总体脂（r =-0.40，P = 0.01）和内脏脂肪（r =-0.58，P = 0.0001）与平均过夜GH浓度呈负相关。在多变量回归模型中，控制年龄、体重指数、体脂和内脏脂肪，只有内脏脂肪是平均GH浓度的显著预测因子（P = 0.0036，模型的r（2）= 0.40）。这些数据表明正常的GH脉冲频率和胰岛素样生长因子-I浓度，但平均GH浓度，基础GH浓度，和GH脉冲幅度在HIV脂肪营养不良患者中的作用。内脏脂肪增多是HIV脂肪营养不良患者GH浓度降低的最强预测因子。进一步的研究是必要的，以确定减少GH在HIV脂肪营养不良患者的临床意义。
Human immunodeficiency virus (HIV) lipodystrophy (LIPO) is characterized by increased visceral adiposity, peripheral fat atrophy, dyslipidemia, and insulin resistance. GH concentrations are known to vary inversely with excess weight and body fat but have not been investigated in HIV lipodystrophy. Twenty-one subjects with HIV LIPO, 20 HIV-infected nonlipodystrophy subjects (NONLIPO), and 20 control (C) subjects were prospectively recruited for this study and compared.Subjects in the three groups were all male, age-matched [median, 47 yr old (interquartile range, 37-50) LIPO; 41 (37-44) NONLIPO; and 43 (37-49) C], and body mass index matched [median, 24.3 kg/m(2) (interquartile range, 22.2-26.6) LIPO; 24.4 (23.3-25.9) NONLIPO; and 24.8 (22.7-26.1) C] (P > 0.05 for all comparisons). Visceral abdominal fat [16,124 mm(2) (11,246 -19,790) LIPO; 7,559 (5,134-11,201) NONLIPO; and 8,803 (6,165-11,623) C; P < 0.01 LIFO vs. NONLIPO and LIFO vs. C] and the ratio of visceral abdominal fat to sc abdominal fat [1.37 (0.71-2.44) LIPO vs. 0.57 (0.47-0.78) NONLIPO vs. 0.55 (0.41-0.71) C, P < 0.01 LIPO vs. NONLIPO and LIPO vs. C] were significantly increased in the LIPO subjects but were not significantly different between NONLIPO and C. The mean overnight GH concentration, determined from frequent sampling every 20 min (from 2000 h to 0800 h) was decreased in the LIFO subjects [0.38 mug/L (0.13-0.67) LIFO vs. 0.96 (0.53-1.30) NONLIPO us. 0.81 (0.49-1.03) C, P < 0.05 LIFO vs. NONLIPO and LIFO vs. C] and not significantly different between NONLIPO and C. Pulse analysis demonstrated decreased baseline GH [0.08 g/L (0.06-0.21) LIPO vs. 0.19 (0.10-0.32) NONLIPO vs. 0.17 (0.12-0.57) C, P < 0.05 LIFO vs. NONLIPO and LIFO vs. C] and GH peak amplitude [1.06 g/L (0.46-1.94) LIFO vs. 2.47 (1.22-3.43) NONLIPO and 2.27 (1.36-4.25) C, P < 0.05 LIPO vs. NONLIPO and LIFO vs. C] in the LIFO subjects but no significant difference in pulse frequency. No significant differences were observed between NONLIPO and C for any GH parameter. Insulin-like growth factor-I was not different between the groups. Total body fat (r = -0.40, P = 0.01) and visceral fat (r = -0.58, P = 0.0001) correlated inversely with mean overnight GH concentrations in the HIV-infected patients. In a multivariate regression model, controlling for age, body mass index, body fat, and visceral fat, only visceral fat was a significant predictor of mean GH concentrations (P = 0.0036, r(2) for model = 0.40).These data demonstrate normal GH pulse frequency and insulinlike growth factor-I concentrations but reduced mean GH concentrations, basal GH concentrations, and GH pulse amplitude in patients with HIV lipodystrophy. Increased visceral adiposity is the strongest predictor of reduced GH concentrations in HIV lipodystrophy. Further studies are necessary to determine the clinical significance of reduced GH in patients with HIV lipodystrophy.