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| 治疗肢端肥大症后的生长激素缺乏状况：一项对生长激素替代疗法进行的随机、安慰剂对照研究 |
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| Growth Hormone Deficiency after Treatment of Acromegaly: A Randomized, Placebo-Controlled Study of Growth Hormone Replacement |
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| Miller KK, Wexler T, Fazeli P 2010/6/22 11:48:26 |
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| J Clin Endocrinol Metab, 2010, |
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| View at Publisher |
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Context:
The effects of GH replacement therapy in patients who develop GH deficiency (GHD) after cure of acromegaly have not been established in a placebo-controlled study.
Objective:
The objective of the study was to determine whether GH replacement improves body composition, cardiovascular risk markers and quality of life in patients with GHD and prior acromegaly.
Design:
This was a 6-month, randomized, placebo-controlled study.
Setting:
The study was conducted at a clinical translational science center.
Study Participants:
Participants included 30 subjects with prior acromegaly and current GHD.
Intervention:
Interventions included GH or placebo.
Main Outcome Measures:
Body composition (dual-energy x-ray absorptiometry and cross-sectional computed tomography at L4), cardiovascular risk markers (high-sensitivity C-reactive protein (hsCRP), total, high-density lipoprotein and low-density lipoprotein cholesterol, fibrinogen, and carotid intimal-medial thickness), and quality of life were measured.
Results:
The mean GH dose at 6 months was 0.58±0.26mg/d. Total fat mass, visceral adipose tissue (−15.3±18.6 vs. 1.3±12.5%, P=0.01), and total abdominal fat decreased, and fat-free mass increased, in the GH vs. placebo group. Mean hsCRP levels decreased, but there was no GH effect on other cardiovascular risk markers. There was no change in glycosylated hemoglobin or homeostasis model assessment insulin resistance index. Quality of life improved with GH. Side effects were minimal.
Conclusions:
This is the first randomized, placebo-controlled study of the effects of GH replacement therapy on body composition and cardiovascular end points in patients who have developed GH deficiency after treatment for acromegaly, a disease complicated by metabolic and body composition alterations and increased cardiovascular risk. GH replacement decreased visceral adipose tissue, increased fat-free mass, decreased hsCRP, and improved quality of life in patients with GHD after cure of acromegaly, with minimal side effects and without an increase in insulin resistance. |
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 疾病资源中心
病例分析 [栏目介绍]
摘自：《西氏内科学》，第23版
患者男性，36岁，幼年有吸入性肺损伤史，因呼吸急促和精神状态改变来我院就诊。患者睡眠和运动时，吸氧流量基值为2 L/min，每天均进行肺功能康复训练。患者居住在美国中西部，入院5天前曾离家乘船来这里看望其兄弟。入院前一天，患者呼吸急促加剧，自觉发热并注意到其慢性咳嗽稍加重，但痰液无变化。当天晚上，家人注意到患者更加急躁并有点偏执。由于症状加重，患者于次日送我院就诊。
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