生长激素替代治疗对垂体功能减退症患者糖脂代谢的影响  

Effects of growth hormone replacement therapy on glucose and lipid metabolism in patients with hypopituitarism

作　　者：郑思畅 张豫文[1] 周薇薇[1] 王文萃[1] 杨毓莹 王卫庆[1] 孙首悦[1] Zheng Sichang;Zhang Yuwen;Zhou Weiwei;Wang Wencui;Yang Yuying;Wang Weiqing;Sun Shouyue(Department of Endocrine and Metabolic Diseases,Shanghai Institute of Endocrine and Metabolic Diseases,Shanghai National Clinical Research Center for Metabolic Diseases,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病研究所,国家代谢性疾病临床医学研究中心,200025

出　　处：《中华内分泌代谢杂志》2022年第10期893-899,共7页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的:探讨生长激素替代治疗(GHRT)对垂体功能减退症患者糖脂代谢的影响。方法:回顾性分析2016年12月至2020年2月在上海交通大学医学院附属瑞金医院内分泌代谢病科接受GHRT的垂体功能减退症患者治疗前后的临床资料,根据治疗前糖代谢状态将患者分为糖调节正常(NGR)组和糖调节受损(IGR)组,分析GHRT前后糖代谢指标的变化。结果:共纳入30例患者,平均年龄(23.0±5.2)岁,其中NGR组23例、IGR组7例。GHRT 12个月后,2组患者空腹血糖(FPG)、葡萄糖负荷后2 h血糖(2hPG)、胰岛素敏感性指数(ISI)与治疗前相比差异均无显著统计学意义(均P>0.05),IGR组稳态模型评估的胰岛素抵抗指数(HOMA-IR)较治疗前显著降低(P<0.05)。NGR组患者中无一例进展为IGR或糖尿病,IGR组7例患者无一例进展为糖尿病,其中4例由糖耐量受损(IGT)恢复至NGR。2组患者三酰甘油、总胆固醇、低密度脂蛋白胆固醇均较治疗前显著降低(均P<0.05)。多元线性回归分析结果显示,体重指数增加是FPG、2hPG升高的独立危险因素(P<0.05)。结论:GHRT 12个月不会对垂体功能减退症患者的葡萄糖稳态产生不利影响,而患者的血脂谱得到显著改善。Objective To investigate the effect of growth hormone replacement therapy(GHRT)on glucose and lipid metabolism in patients with hypopituitarism.Methods Clinical data of patients with hypopituitarism who received GHRT in Department of Endocrine and Metabolic Diseases,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 2016 to February 2020 were retrospectively analyzed.The patients were divided into normal glucose regulation(NGR)group and impaired glucose regulation(IGR)group according to their glucose metabolism status before GHRT.The changes of the characteristics of glucose metabolism before and after GHRT were analyzed.Results A total of 30 patients aged(23.0±5.2)years were included,23 patients in NGR group and 7 patients in IGR group.After 12 months of GHRT,there were no significant changes in fasting plasma glucose(FPG),2-hour postprandial plasma glucose(2hPG),and insulin sensitivity index(ISI)in both groups(all P>0.05),while homeostasis model assessment insulin resistance(HOMA-IR)in IGR group was significantly decreased compared with that before GHRT(P<0.05).None of the patients in NGR group progressed to IGR or diabetes mellitus,and none of the 7 patients in the IGR group progressed to diabetes mellitus,while 4 of them recovered from impaired glucose tolerance(IGT)to NGR.Triglyceride,total cholesterol,and low density lipoprotein-cholesterol levels were all significantly decreased in two groups(all P<0.05).Multivariate linear regression analysis showed that the increase of body mass index was an independent risk factor for the increase of FPG and 2hPG(P<0.05).Conclusion 12-month GHRT significantly improved their blood lipid profiles in patients with hypopituitarism without adversely affecting glucose homeostasis.

关 键 词：垂体功能减退症 生长激素替代治疗 葡萄糖代谢 体重指数 

分 类 号：R584.2[医药卫生—内分泌]