特纳综合征患者的碳水化合物代谢。生长激素、奥雄龙和两者联合治疗的效果。

Jerzy Starzyk
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引用次数: 0

摘要

未标记:大约25%的特纳综合征(TS)女孩存在胰岛素抵抗或胰岛素降低血糖水平的能力受损。生长激素(hGH),尤其是以药理学剂量给药时,可能会对TS女孩的碳水化合物代谢产生负面影响,改变外周组织对胰岛素的反应。该报告的目的是评估葡萄糖和胰岛素释放以及生理条件下胰岛素抵抗的流行情况(基线和标准餐后值),以及Turner综合征患者在接受生长激素、奥胺龙(Ox)和这两种药物联合(hGH+Ox)治疗6个月后的口服和静脉葡萄糖耐量试验。作者还评估了这三种治疗方法对碳水化合物代谢的影响,试图确定葡萄糖不耐受、2型糖尿病、高胰岛素血症和胰岛素抵抗的风险。对所有患者的个体结果分析显示,1例接受联合治疗的患者符合诊断2型糖尿病的实验室标准(120分钟血糖OGTT >12.2 mmol/l)。葡萄糖耐受不良(IGT)在未治疗的女孩中通常见于12.5%,在hGH或Ox治疗6个月后没有加重,但在联合治疗的患者中更为明显。在接受hGH和hGH+Ox治疗的患者中,有空腹高胰岛素血症(>25 uLI/ml)的趋势,在接受联合治疗的女孩中,胰岛素抵抗(IR15)更为明显。结论:生长激素联合奥雄龙治疗可显著增加胰岛素分泌,增加胰岛素抵抗。鉴于胰岛素抵抗的影响,应分析生长激素与奥胺龙联合治疗女孩特纳综合征的可行性。
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[Carbohydrate metabolism in patients with Turner syndrome. The effect of therapy with growth hormone, oxandrolone and a combination of both].

Unlabelled: Insulin resistance or the impairment of insulin capability to decrease blood glucose levels is seen in approximately 25% of girls with Turner syndrome (TS). Growth hormone (hGH), especially when administered at pharmacological doses, may additionally negatively affect the carbohydrate metabolism in TS girls, changing the response of peripheral tissues to insulin. The aim of the report was the assessment of glucose and insulin release and the prevalence of insulin resistance in physiological conditions (baseline and post-standard meal values), as well as after oral and IV glucose tolerance test in patients with Turner syndrome after a 6-month therapy with growth hormone, oxandrolone (Ox) and a combination of these two agents (hGH+Ox). The authors also evaluated the effect of these three therapeutic methods on carbohydrate metabolism, attempting to define the risk of glucose intolerance, type 2 diabetes and hyperinsulinemia and insulin resistance. The analysis of individual results in all the patients revealed that laboratory criteria for diagnosis type 2 diabetes (glycemia at 120 min OGTT >12.2 mmol/l) were met by one patient subjected to a combined therapy. Glucose intolerance (IGT) in OGTT, normally seen in 12.5% of untreated girls, was not intensified following a 6-month hGH or Ox therapy, but was more pronounced in patients on the combined treatment. A tendency was seen towards fasting hyperinsulinism (>25 uLI/ml) in patients on hGH and hGH+Ox, with more pronounced insulin resistance (IR1<7, IR2>5) in girls on the combined therapy.

Conclusions: Combined treatment with growth hormone and oxandrolone results in a significant increase of insulin secretion and increased insulin resistance. In view of the effects of insulin resistance, one should analyze the advisability of combined treatment with growth hormone and oxandrolone in girls with Turner syndrome.

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