Short-term effects of growth hormone (GH) treatment or deprivation on cardiovascular risk parameters and intima-media thickness at carotid arteries in patients with severe GH deficiency
Short-term effects of growth hormone (GH) treatment or deprivation on cardiovascular risk parameters and intima-media thickness at carotid arteries in patients with severe GH deficiency
复制标题
DOI：
10.1210/jc.2004-2247
复制
发表时间：
2005-04-01
影响因子：
5.8
通讯作者：
Lombardi, G
中科院分区：
文献类型：
--
作者：
Colao, A;Di Somma, C;Lombardi, G
为了探索生长激素治疗或剥夺对心血管危险因素和颈动脉内膜中层厚度(IMT)的早期影响，我们设计了这项随机、交叉研究，对象为34名患有严重生长激素缺乏的成人患者。研究开始时，患者被随机分为两组(A组和B组)，A组(n=17)接受适当的替代治疗，包括标准剂量的GH，为期6个月，然后停止GH治疗6个月；B组(n=17)在不含生长激素的基础上进行6个月的适当替代治疗，并在随后的6个月内加用生长激素。在前6个月后，我们观察到A组患者的IGF-I水平和高密度脂蛋白-胆固醇水平显著升高，而舒张压、总/高密度脂蛋白-胆固醇比值和C-反应蛋白水平显著下降，而血管参数无明显变化。在B组患者中，研究的各项参数均无显著变化。停用生长激素6个月后，A组患者血清IGF-I水平显著降低，总/高密度脂蛋白-胆固醇比值和C-反应蛋白显著升高，颈动脉内膜中层厚度和峰值速度有受损趋势。B组患者应用生长激素后，IGF-I水平显著升高，收缩压、舒张压、总胆固醇、总胆固醇/高密度脂蛋白胆固醇比值、C反应蛋白显著降低，高密度脂蛋白胆固醇水平升高，血管参数有改善趋势。研究结束时，A组和B组的平均内中膜厚度均显著低于基线水平(从0.88±0.28到0.85±0.27 mm，P=0.0003)和B组(从0.83±-0.21 mm到0.80±0.20 mm，P=0.003)。这些发现支持成人严重生长激素缺乏症患者进行生长激素替代治疗的指征。
To explore early effects of GH treatment or deprivation on cardiovascular risk factors and carotid intima-media thickness (IMT), we designed this randomized, cross-over study in 34 adult patients with severe GH deficiency. At study entry, the patients were randomized into two groups ( A and B); group A ( n = 17) received appropriate replacement therapy including GH at standard doses for 6 months and then were withdrawn from GH for the subsequent 6 months; group B( n = 17) received appropriate replacement therapy excluding GH for 6 months with the addition of GH in the subsequent 6 months.After the first 6 months, we observed a significant increase in IGF-I levels and of high-density lipoprotein (HDL)-cholesterol together with a significant decrease in diastolic blood pressure, the total/HDL-cholesterol ratio, and C-reactive protein in the patients in group A, whereas vascular parameters did not significantly change. In the patients in group B, none of the parameters studied significantly changed. After 6 months of GH withdrawal in the patients in group A, a significant decrease in IGF-I levels, a significant increase in the total/HDL-cholesterol ratio and C-reactive protein, and a trend toward an impairment of carotid IMT and peak velocities were observed. In the patients in group B, the addition of GH to the standard replacement induced a significant increase in IGF-I levels together with a decrease in systolic and diastolic blood pressure, total cholesterol and total/HDL-cholesterol ratio, and C-reactive protein, and an increase in HDL-cholesterol levels with a trend toward an improvement of vascular parameters. At the end of the study, mean IMT was significantly lower than at baseline both in group A ( from 0.88 +/- 0.28 to 0.85 +/- 0.27 mm, P = 0.0003) and in group B ( from 0.83 +/- 0.21 to 0.80 +/- 0.20 mm, P = 0.003).In conclusion, 6 months of GH replacement has beneficial effects whereas 6 months of GH deprivation has detrimental effects on cardiovascular risk factors and atherosclerosis. These findings support the indication for GH replacement in severe GH deficiency adult patients.