الفهرس | Only 14 pages are availabe for public view |
Abstract This prospective case control study was conducted on ٢٣ patients with GHD and ١٤ healthy matched children serving as a control group. All subjects were recruited from Endocrinology clinic, Children’s hospital, Ain Shams University during the period from December ٢٠١٠ till February ٢٠١٣. Subjects with history of old or current GH replacement therapy, with previous or current cardiovascular (CVD), respiratory, renal, gastro-intestinal or other endocrinal disease as well as malnutrition were excluded from the study. All subjects were subjected to anthropometric measurements (height, height SDS, BMI, BMI SDS and growth velocity with its SDS); and measurement of heart rate, systolic and diastolic blood pressure at the start of study. In addition, fasting lipid profile, ghrelin and leptin were measured in all subjects. Also, detailed cardiologic examination was done by transthoracic echocardiography to all subjects commenting on cardiac dimensions, mass and thickness by left ventricular diameters in both systole and diastole, left ventricular wall and septum thickness in diastole as well as left ventricular mass. Ejection fraction, fractional shortening and myocardial performance index assessed the systolic function. Both Doppler imaging and tissue Doppler imaging assessed diastolic function by measuring isovolumetric relaxation time, waves of early and late diastolic filling at both mitral and tricuspid annulus. Also the carotid intima thickness was measured by carotid sonography. Growth hormone provocation testing by insulin and clonidine was done only for patients and only at start of study.GHD patients received GH therapy in a dose of ٠٫٢ mg/kg/dose ٦- ٧ days/week, given subcutaneously at night. All subjects were followed up for one year then all the previously mentioned data were re-assessed. Four patients were lost to follow up as well as ٥ controls. Results are as follows: o On comparing baseline auxologic criteria in untreated GHD patients with the control group it was found that their height SDS was significantly less. The height SDS increased significantly after one-year treatment with GH in the patients yet when compared to controls it was still statistically less. o Baseline and after one year follow up systolic blood pressure was found to be significantly higher in patients than controls, however there was no change in systolic blood pressure after GH therapy. o Diastolic blood pressure was not different at baseline or after one year of GH therapy between the two groups. o Heart rate was significantly higher in the patients at start of study while after one-year GH therapy there was no statistical difference. o Cardiac LV dimensions, mass index and thickness showed no difference between the two groups at baseline as well as after one year follow up. The LV mass, end diastolic and systolic volume indices as well as posterior wall and septum thickness increased significantly after one year therapy with GH in the studied patients. o The untreated GHD patients when compared to controls showed significant impairment in diastolic functions. The diastolic functions did not show any difference after one year follow up between the two groups, yet they improved significantly in the patients after one year therapy. o There was no significant difference in systolic functions either at baseline or after one-year therapy between the two groups. o The carotid intima thickness was comparable between the two groups at both baseline and after one-year therapy. It was significantly evident that it decreased after one-year therapy with GH in the studied cases. o Blood lipids at start of study did not show significant difference between cases and controls. After GH therapy for one year, total cholesterol, triglycerides and the atherogenesis index significantly decreased while HDL significantly increased. o Ghrelin levels were comparable between the two groups at baseline and after one year follow up. Also the cases did not show any difference in ghrelin levels with or without treatment with GH. o Leptin was comparable between controls and treated and untreated GHD patients. o GH levels did not correlate with any of the echocardiographic or laboratory investigations.o Ghrelin in treated GHD patients correlated negatively with Em/Am denoting that the higher the ghrelin levels the better the LV diastolic function. o Leptin in untreated patients correlated positively with LVEDd suggesting a possible effect of leptin on cardiac dimensions and myocardial function in patients with GHD. o Total cholesterol in untreated GHD patients correlated positively with E’t/A’t meaning that the higher levels of cholesterol were associated with impaired LV diastolic functions. o Also total cholesterol correlated with indices of impaired systolic function as shown by negative relation with myocardial performance index. o HDL in untreated GHD patients correlated negatively with Em/Am suggesting that it was higher in patients with better LV diastolic function. o LDL in untreated patients correlated negatively with A’t and positively with E’t/A’t, adding to what was evidenced with other lipids in relation to LV diastolic impairment. |