Effects of Recombinant Human Growth Hormone in Anorexia Nervosa: A Randomized, Placebo-Controlled Study
Effects of Recombinant Human Growth Hormone in Anorexia Nervosa: A Randomized, Placebo-Controlled Study
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DOI：
10.1210/jc.2010-0493
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发表时间：
2010-11-01
影响因子：
5.8
通讯作者：
Klibanski, Anne
中科院分区：
文献类型：
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作者：
Fazeli, Pouneh K.;Lawson, Elizabeth A.;Klibanski, Anne
背景：神经性厌食症是一种慢性营养缺乏状态，以生长激素抵抗、生长激素水平升高和胰岛素样生长因子-I水平降低为特征。超生理学重组人生长激素(RhGH)对AN生长激素抵抗的影响目前尚不清楚。目的：探讨重组人生长激素(RhGH)能否提高AN患者血清IGF-I水平。设计和地点：我们在临床研究中心进行了一项随机、安慰剂对照研究。患者：我们研究了21名AN患者，10名(平均年龄28±2.1岁)接受重组生长激素治疗，11名(平均年龄29.2±2.6岁)接受安慰剂治疗。干预：给予重组人生长激素(平均每日最大剂量，1.4+/-0.12 mg/d)或安慰剂治疗12wk。主要观察指标：分别于第0，1，2，3，4，8，12周测定胰岛素样生长因子I、I型前胶原N端肽、I型胶原C端肽、血糖、胰岛素水平；用双能X线骨密度仪测定体成分，包括总脂肪和瘦体重。结果：两组治疗前和治疗后胰岛素样生长因子-I水平无明显差异(12周重组人生长激素治疗后中位数为124 ng/ml，四分位数范围为94.5,170.3；安慰剂组为85.5 ng/ml，四分位数范围为62,139；P=0.3)。同样，血糖、胰岛素、游离脂肪酸和骨骼标记物的变化在两组之间没有差异。尽管体重相当，但重组人生长激素组的总脂肪质量和脂肪质量百分比(重组人生长激素，-2.5%+/-0.6%，与安慰剂组的2.2%/-1.1%；P=0.004)显著低于安慰剂组。结论：重组人生长激素的超生理给药减少了AN的脂肪质量，而不增加IGF-I水平，支持GH作为独立于IGF-I的脂解介质的作用。(临床内分泌代谢酶95：4889-4897,2010)
Context: Anorexia nervosa (AN), a state of chronic nutritional deprivation, is characterized by GH resistance with elevated GH levels and decreased levels of IGF-I. The effects of supraphysiological recombinant human GH (rhGH) on GH resistance in AN are not currently known. Objective: The aim was to investigate whether supraphysiological rhGH increases IGF-I levels in AN. Design and Setting: We conducted a randomized, placebo-controlled study in a Clinical Research Center. Patients: We studied 21 women with AN, 10(mean age, 28 +/- 2.1 yr) treated with rhGH and 11(mean age, 29.2 +/- 2.6 yr) treated with placebo. Interventions: rhGH (mean maximum daily dose, 1.4 +/- 0.12 mg/d) or placebo was administered to patients for 12 wk. Main Outcome Measures: IGF-I, N-terminal propeptide of type 1 procollagen, type I collagen C-telopeptide, glucose, and insulin levels were measured at wk 0, 1, 2, 3, 4, 8, and 12; C-terminal propeptide of type 1 procollagen, leptin, and free fatty acid levels were measured at wk 0 and 12. Body composition, including total fat and lean mass, was measured by dual-energy x-ray absorptiometry at wk 0 and 12. Results: IGF-I levels did not differ between the groups at baseline or after treatment (median after 12 wk-rhGH, 124 ng/ml, interquartile range, 94.5, 170.3; vs. placebo, 85.5 ng/ml, interquartile range, 62, 139; P = 0.3). Similarly, changes in glucose, insulin, free fatty acids, and bone markers did not differ between the groups. Total fat mass and percentage fat mass (rhGH, -2.5 +/- 0.6%, vs. placebo, 2.2 +/- 1.1%; P = 0.004) decreased significantly in the rhGH group compared to placebo despite comparable weight. Conclusions: Supraphysiological rhGH administration decreases fat mass in AN without increasing IGF-I levels, supporting the role of GH as a mediator of lipolysis independent of IGF-I. (J Clin Endocrinol Metab 95: 4889-4897, 2010)