切换至 "中华医学电子期刊资源库"
高级检索
中华诊断学电子杂志

中华诊断学电子杂志 ›› 2018, Vol. 06 ›› Issue (01) : 48 -52. doi: 10.3877/cma.j.issn.2095-655X.2018.01.010

所属专题： 文献；

临床研究

儿童生长激素缺乏症患者血清血脂水平与心外膜脂肪厚度的相关性研究
李艳英1, 张梅1, 王少春2, 刘丹丹2, 晏文华1, 班博1,†()   
  1. 1. 272029　济宁医学院附属医院内分泌科
    2. 272029　济宁医学院附属医院超声科
  • 收稿日期:2017-12-30 出版日期:2018-02-26
  • 通信作者: 班博
  • 基金资助:
    济宁市科技局资助项目(济科字（2015）57号-11)

The correlation between serum lipid level and epicardial fat thickness in children with growth hormone deficiency

Yanying Li1, Mei Zhang1, Shaochun Wang2, Dandan Liu2, Wenhua Yan1, bo Ban1,†()   

  1. 1. Department of Endocrinology, the Affiliated Hospital of Jining Medical University, Jining 272029, China
    2. Department of Ultrasound, the Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2017-12-30 Published:2018-02-26
  • Corresponding author: bo Ban
  • About author:
    Corresponding author: Banbo, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李艳英, 张梅, 王少春, 刘丹丹, 晏文华, 班博. 儿童生长激素缺乏症患者血清血脂水平与心外膜脂肪厚度的相关性研究[J/OL]. 中华诊断学电子杂志, 2018, 06(01): 48-52.

Yanying Li, Mei Zhang, Shaochun Wang, Dandan Liu, Wenhua Yan, bo Ban. The correlation between serum lipid level and epicardial fat thickness in children with growth hormone deficiency[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2018, 06(01): 48-52.

目的

观察儿童生长激素缺乏症(GHD)患者心外膜脂肪组织(EAT)厚度的变化，探讨生长激素缺乏对GHD患儿体脂代谢的影响。

方法

应用巢式病例对照研究方法，收集2017年1月至10月在济宁医学院附属医院内分泌科住院的身材矮小患者，共59例，按照生长激素激发试验结果将患者分为3组：A组为生长激素完全缺乏组[生长激素峰值(GHmax)<0.24 nmol/L]，20例；B组为生长激素部分缺乏组(0.24 nmol/L≤GHmax<0.47 nmol/L)，24例；C组为生长激素正常组(GHmax>0.47 nmol/L)，15例。应用超声心动图检测每例患者EAT厚度，同时收集患者的一般资料、血清血脂、生长激素水平，胰岛素样生长因子(IGF-1)及骨龄等指标。

结果

3组EAT厚度比较差异有统计学意义(F＝4.13，P<0.05)，其中A组(2.70±0.87)较B组(2.20±0.81)及C组(2.00±0.47)高(P<0.05)，而B组与C组比较差异无统计学意义(P>0.05)；应用平滑曲线拟合与阈值效应分析发现在甘油三酯(TG)≥0.9 mmol/L时，EAT厚度与TG水平呈正相关(β＝2.0，P<0.05)。

结论

GHD患儿EAT厚度增加，该表现早于脂代谢异常出现之前。

关键词: 生长激素缺乏, 心外膜脂肪, 脂代谢障碍
Objective

To observe the change of epicardial adipose tissue (EAT) thickness in children with growth hormone deficiency(GHD), and explore the effect of growth hormone deficiency on lipid metabolism.

Methods

Using nested case-control study method, 59 patients who were diagnosed with short stature in the Affiliated Hospital of Jining Medical University from January 2017 to October 2017 were selected.According to the growth hormone stimulation test results, all patients were divided into three groups: growth hormone deficiency group (GHmax<0.24 nmol/L) (group A), partial growth hormone deficiency group (0.24 nmol/L≤GHmax<0.47 nmol/L) (group B), normal growth hormone group (GHmax≥0.47 nmol/L) (group C). EAT thickness was tested by echocardiography, meanwhile general information and related results were collected, such as blood lipid, growth hormone, insulin-like growth factor (IGF-1) and bone age etc.

Results

EAT thickness was different in three groups (F=4.13, P<0.05), which was thicker in group A (2.70±0.87)compared with group B(2.20±0.81) and group C(2.00±0.47) (P<0.05), and there was no statistical difference between group B and group C (P>0.05). Smooth curve fitting and threshold effect analysis showed that EAT thickness and triglyceride (TG) were positively correlated (β=2.0, P<0.05), when TG level was higher than 0.9 mmol/L.

Conclusion

EAT thickness is increased in children with GHD and occurrs before abnormality lipid appears.

Key words: Growth hormone deficiency, Epicardial adipose tissue, Lipid metabolism disorders
表1 3组矮小症患者一般资料情况比较
指标 A组(n＝20) B组(n＝24) C组(n＝15) 统计量 P值
年龄(岁，±s) 10.5±2.6 10.4±2.6 10.6±2.8 F＝ 0.04 >0.05
身高(cm，±s) 132.4±13.9 130.0±14.3 134.9±17.0 F＝ 0.49 >0.05
体质量(kg，±s) 34.9±12.1ab 26.5±6.9 30.7±9.6 F＝ 4.19 <0.05
BMI(kg/m2，±s) 19.3±3.8ab 15.4±1.9 16.4±1.9 F＝11.61 <0.01
出生体质量(kg，±s) 3.2±0.4 3.2±0.5 3.3±0.4 F＝ 1.71 >0.05
出生身长(cm，±s) 51.4±2.4 49.5±3.0 50.1±0.4 F＝ 0.31 >0.05
父亲身高(cm, ±s) 166.8±5.0 167.4±6.2 168.9±3.1 F＝ 0.68 >0.05
母亲身高(cm, ±s) 155.9±6.3 156.2±5.8 158.6±4.8 F＝ 1.09 >0.05
骨龄(岁，±s) 9.1±3.3 8.8±2.7 9.2±3.6 F＝ 0.06 >0.05
性别(例，%) ? ? ? χ2＝ 3.23 >0.05
? 男 17(85.0) 15(62.5) 12(80.0) ? ?
? 女 3(15.0) 9(37.5) 3(20.0) ? ?
表2 3组矮小症患者代谢指标及心外膜脂肪厚度的比较(±s)
指标 A组(n＝20) B组(n＝24) C组(n＝15) F值 P值
FBG(mmol/L) 4.60±0.48 4.72±0.49 4.48±0.44 1.21 >0.05
TG(mmol/L) 0.85±0.53 0.72±0.27 0.69±0.21 0.91 >0.05
TC(mmol/L) 4.11±0.62 4.11±0.82 3.69±0.55 2.07 >0.05
LDL(mmol/L) 2.29±0.43 2.23±0.49 2.07±0.49 0.93 >0.05
UA(μmol/L) 261.90±64.31 278.30±67.94 275.00±62.32 0.36 >0.05
IGFBP-3(μg/ml) 4.00±0.71 4.21±1.20 4.10±1.02 0.14 >0.05
IGF-1(μg/L) 181.50±71.69 199.60±89.71 255.70±159.90 2.18 >0.05
L-GHmax(μg/L) 3.03±1.28ab 6.79±1.71a 11.65±2.45 97.60 <0.01
In-GHmax(μg/L) 2.24±1.19ab 4.74±2.38a 9.73±7.73 13.27 <0.01
EAT厚度(mm) 2.70±0.87ab 2.20±0.81 2.00±0.47 4.31 <0.05
表3 矮小症患者TG水平与EAT厚度相关性阈值效应分析
TG水平的拐点(mmol/L) β(95%CI) P值
<0.9 －0.9(－1.8～0.1) >0.05
≥0.9 2.0(1.2～2.9) <0.05
图1 矮小症患者甘油三酯水平与心外膜脂肪组织厚度相关性曲线拟合图
[1]
Molitch ME，Clemmons DR，Malozowski S，et al.Evaluation and treatment of adult growth hormone deficiency：an Endocrine Society Clinical Practice Guideline[J]．Nat Clin Pract Cardiovasc Med，2011，96(6):1587-1609.
[2]
Iacobellis G, Corradi D, Sharma AM.Epicardial adipose tissue：anatomic，biomolecular and clinical relationships with the heart[J]．Nat Clin Pract Cardiovasc Med，2005，2(10):536-543.
[3]
Bertaso AG，Bertol D，Duncan BB，et al.Epicardial fat：definition, measurements and systematic review of main outcomes[J]．Arq Bras Cardiol，2013，101(1):E18-E28.
[4]
刘思思，班博，潘慧，等．济宁地区6～16岁儿童青少年矮小症患病现况研究[J/CD]．中华诊断学电子杂志，2017，5(3):191-194.
[5]
Eroglu S，Sade LE，Yildirir A，et al.Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease[J]．Nutr Metab Cardiovasc Dis, 2009, 19(3):211-217.
[6]
张沫，李昭屏，李卫虹，等．非冠心病胸痛患者心外膜脂肪与冠状动脉血流储备的相关性[J]．北京大学学报(医学版), 2014(6):848-853.
[7]
Gleeson H，Barreto ES，Salvatori R，et al.Metabolic effects of growth hormone (GH) replacement in children and adolescents with severe isolated GH deficiency due to a GHRH receptor mutation[J]．Clin Endocrinol (Oxf)，2010，66(4):466-474.
[8]
Rothermel J，Lass N，Bosse C，et al.Impact of discontinuation of growth hormone treatment on lipids and weight status in adolescents[J]．J Pediatr Endocrinol Metab，2017，30(7):749-757.
[9]
De Leonibus C, De Marco S, Stevens A, et al.Growth hormone deficiency in prepubertal children: predictive markers of cardiovascular disease[J]．Horm Res Paediatr，2016，85(6):363-371.
[10]
Johansson JO, Landin K, Tengborn L, et al.High fibrinogen and plasminogen activator inhibitor activity in growth hormone-deficient adults[J]．Arterioscler Thromb，1994，14(3):434-437.
[11]
Colao A．The GH-IGF-I axis and the cardiovascular system：clinical implications[J]．Clin Endocrinol (Oxf)，2008，69(3):347-358.
[12]
Davis PH, Dawson JD, Riley WA, et al.Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age：the muscatine study[J]．Circulation，2001，104(23):2815-2819.
[13]
Knop C, Wolters B, Lass N, et al.Carotid intima-media thickness in children treated with growth hormone[J]．J Pediatr Endocrinol Metab，2015，28(9-10):985-991.
[14]
Rothermel J, Reinehr T．Metabolic alterations in paediatric GH deficiency[J]．Best Pract Res Clin Endocrinol Metab，2016，30(6): 757-770.
[15]
Iacobellis G, Leonetti F．Epicardial adipose tissue and insulin resistance in obese subjects[J]．J Clin Endocrinol Metab，2005，90(11):6300.
[16]
Sacks HS，Fain JN.Human epicardial adipose tissue：a review[J]．American Heart Journal，2007，153(6):907-917.
[17]
Iacobellis G．Epicardial adipose tissue in endocrine and metabolic diseases[J]．Endocrine，2014，46(1):8-15.
[18]
Schweizer R，Martin DD，Schönau E，et al.Muscle function improves during growth hormone therapy in short children born small for gestational age: results of a peripheral quantitative computed tomography study on body composition[J]．J Clin Endocrinol Metab，2008，93(8):2978-2983.
[19]
Jørgensen AP, Fougner KJ, Ueland T, et al.Favorable long-term effects of growth hormone replacement therapy on quality of life, bone metabolism, body composition and lipid levels in patients with adult-onset growth hormone deficiency[J]．Growth Horm IGF Res，2011，21(2):69-75.
[20]
Khadilkar V, Ekbote V, Kajale N, et al.Effect of one-year growth hormone therapy on body composition and cardio-metabolic risk in Indian children with growth hormone deficiency[J]．Endocr Res，2014，39(2):74-78.
[21]
Lanes R，Soros AK，Gunczler P，et al.Endothelial function，carotid artery intima-media thickness, epicardial adipose tissue, and left ventricular mass and function in growth hormone-deficient adolescents：apparent effects of growth hormone treatment on these parameters[J]．J Clin Endocrinol Metab，2005，90(7):3978-3982.
[22]
Misra M, Bredella MA, Tsai P, et al.Lower growth hormone and higher cortisol are associated with greater visceral adiposity，intramyocellular lipids, and insulin resistance in overweight girls[J]．Am J Physiol Endocrinol Metab，2008，295(2):385-392.
[1] 张梅青, 李越, 王秋霜, 翟亚楠, 魏丽群, 黄党生. 超声测量的心外膜脂肪厚度与心房颤动的相关性[J/OL]. 中华医学超声杂志（电子版）, 2017, 14(03): 186-192.
[2] 陈叶飞, 付笑影. 脂代谢在乳腺癌发生、发展及耐药中的作用机制[J/OL]. 中华乳腺病杂志(电子版), 2020, 14(02): 112-115.
[3] 李英纳, 李敏, 周澳洋, 李平, 杨凡. 肥胖症儿童血浆脑源性神经营养因子水平及其代谢异常的相关性研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(01): 81-88.
[4] 匡德凤, 李志国, 华绍芳, 薛凤霞. 高脂诱导孕鼠血清及胎盘组织脂肪酸结合蛋白-4及相关脂蛋白水平变化及其意义[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 338-344.
[5] 赵玲霞, 曾凌空, 蔡保欢, 袁文浩. BSCL2基因突变导致先天性全身脂肪营养不良患儿的诊治并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2021, 17(05): 574-581.
[6] 徐煜琛, 李璐, 薛冬令, 赵德伟. 外泌体介导股骨头坏死机制与治疗的研究进展[J/OL]. 中华损伤与修复杂志(电子版), 2022, 17(03): 247-252.
[7] 江梓杰, 肖泽宇, 马孟杰, 史长征. 心脏磁共振成像在肥胖症及治疗的应用[J/OL]. 中华肥胖与代谢病电子杂志, 2020, 06(04): 247-251.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号