Acquired growth hormone resistance in patients with chronic heart failure: Implications for therapy with growth hormone
Acquired growth hormone resistance in patients with chronic heart failure: Implications for therapy with growth hormone
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DOI：
10.1016/s0735-1097(01)01385-7
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发表时间：
2001-08-01
影响因子：
24
通讯作者：
Coats, AJS
中科院分区：
文献类型：
--
作者：
Anker, SD;Volterrani, M;Coats, AJS
目的：我们的目的是确定是否生长激素（GH）抵抗是存在于慢性心力衰竭（CHF）患者，以及它是否可能与生化反应GH treatment.Background获得性GH抵抗是一个严重的疾病，特别是恶病质的特点。在CHF患者中，GH治疗的反应似乎是variable.Methods GH-胰岛素样生长因子-I（IGF-I）轴的生化标志物进行了比较，在21例CHF恶病质患者，51例非恶病质患者和26例健康对照组。在单独的研究中，分析了基线生化变量对IGF-I对GH治疗反应的预测价值。与非恶病质患者相比，GH结合蛋白（BP）（p = 0.005）、IGF-BP 3（p = 0.01）和IGF-I（p = 0.06）降低。恶病质组与对照组相比，也有类似的变化。非恶病质患者和对照组之间无差异。在所有亚组中，GH-BP水平与IGF-UGH比值相关（所有p均小于或等于0.002）。基线GH-BP水平与CHF患者GH治疗24小时后IGF-I水平升高相关（r = 0.83，p = 0.005; n = 9;研究2），44天（r = 0.52，p = 0.007; n = 25;研究3）和96天（r = 0.54，p = 0.006; n = 24;研究3）结论大多数恶病质和部分非恶病质CHF患者存在获得性GH抵抗。GH抵抗的生化特征和对短期和长期GH治疗的不良生化反应的主要预测因子是GH-BP血浆水平。GH抵抗的存在可能是决定CHF患者对GH治疗反应的主要因素。（美国科尔心脏病学杂志2001;38：443-52）（C）2001年美国心脏病学会。
Objectives We aimed to determine whether growth hormone (GH) resistance is present in patients with chronic heart failure (CHF) and whether it may be linked to the biochemical response to GH treatment.Background Acquired GH resistance is a feature of severe illness, in particular, cachexia. In patients with CHF, the response to GH therapy appears to be variable.Methods Biochemical markers of the GH-insulin-like growth factor-I (IGF-I) axis were compared in 21 cachectic patients with CHF, 51 noncachectic patients and 26 healthy control subjects. In separate studies, the predictive value of baseline biochemical variables for the IGF-I response to GH treatment was analyzed.Results Cachectic patients showed an increase of total GH and immunologically intact GH (p less than or equal to 0.0002) and a decrease of GH-binding protein (BP) (p = 0.005), IGF-BP3 (p = 0.01) and IGF-I (p = 0.06), compared with noncachectic patients. Similar changes were found when the cachectic group was compared with the control group. No differences were found between noncachcctic patients and control subjects. Levels of GH-BP correlated with the IGF-UGH ratio in all subgroups (all p less than or equal to 0.002). Baseline GH-BP levels were related to the increase of IGF-I levels in response to GH treatment in patients with CHF after 24 h (r = 0.83, p = 0.005; n = 9; study 2), 44 days (r = 0.52, p = 0.007; n = 25; study 3) and 96 days (r = 0.54, p = 0.006; n = 24; study 3).Conclusions Most cachectic and some noncachectic patients with CHF show features of acquired GH resistance. The principal predictors of the biochemical features of GH resistance and of the poor biochemical response to short-term and longer-term GH treatment are GH-BP plasma levels. The presence of GH resistance is potentially a major factor determining the response to GH therapy in patients with CHF. (J Am Coll Cardiol 2001;38:443-52) (C) 2001 by the American College of Cardiology.