Cardiac effects of growth hormone treatment in chronic heart failure: A meta-analysis
Cardiac effects of growth hormone treatment in chronic heart failure: A meta-analysis
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DOI：
10.1210/jc.2006-1313
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发表时间：
2007-01-01
影响因子：
5.8
通讯作者：
Maison, Patrick
中科院分区：
文献类型：
--
作者：
Le Corvoisier, Philippe;Hittinger, Luc;Maison, Patrick
背景：实验研究表明，生长激素治疗可以改善慢性心力衰竭（CHF）的心血管参数。然而，临床试验涉及的患者人数少，并没有让一个结论，以得出这种治疗在human.Objective的效果：我们系统地回顾和分析了所有的随机对照试验和开放性研究的持续生长激素治疗CHF.Study选择：12个试验中确定了三个数据库。我们对GH对心血管参数的影响进行了综合分析，使用总体效应量来评估显著性，并计算有和无治疗的加权平均差异来评估效应量。数据合成：GH治疗显著改变了形态学心血管参数[室间隔厚度，+ 0.55（标准差，0.43）mm（P < 0.001）;后壁厚度，+1.01（0.44）毫米左室舒张末期内径为-2.02（1.22）毫米左室收缩末期内径为-5.30（2.33）毫米左室和全身血流动力学[左室收缩末期室壁应力，-38.9左室射血分数+5.10（1.74）%（P <0.05），体循环阻力+195.0（204.5）dyn（.）秒（-1.）cm（-5）（P < 0.01）];功能参数[纽约心脏协会分级，-0.97（0.23）（P < 0.01）;运动持续时间，+103.7（37.6）sec（P < 0.001）;最大摄氧量，+2.48（1.76）ml/kg（.）min（P < 0.01）]。亚组分析和荟萃回归分析显示IGF-I反应和GH治疗effects.Conclusion之间存在显著关系：我们的荟萃分析表明，GH治疗可改善CHF患者的几个相关心血管参数。然而，这些结果必须通过一项大型随机安慰剂对照试验证实，该试验是关于CHF患者长期高剂量GH治疗期间的血流动力学、形态学和功能参数。
Context: Experimental studies suggest that GH treatment may improve cardiovascular parameters in chronic heart failure (CHF). However, clinical trials involved small numbers of patients and did not allow a conclusion to be drawn on the effect of this treatment in humans.Objective: We systematically reviewed and analyzed all randomized controlled trials and open studies of sustained GH treatment in CHF.Study Selection: Twelve trials were identified in three databases. We conducted a combined analysis of GH effects on cardiovascular parameters using the overall effect size to evaluate significance and computing the weighted mean differences with and without treatment to assess effect size.Data Synthesis: GH treatment significantly modified morphological cardiovascular parameters [interventricular septum thickness, + 0.55 (SD, 0.43) mm(P < 0.001); posterior wall thickness, +1.01 (0.44) mm (P < 0.01); left ventricle (LV) end-diastolic diameter, -2.02 (1.22) mm (P < 0.01); and LV end-systolic diameter, -5.30 (2.33) mm (P < 0.05)]; LV and systemic hemodynamics [LV end-systolic wall stress, -38.9 (13.3) dynes/cm(2) (P < 0.001); LV ejection fraction, +5.10 (1.74)% (P < 0.05); and systemic vascular resistance, +195.0 (204.5) dyn(.)sec(-1.)cm(-5) (P < 0.01)]; and functional parameters [New York Heart Association class, -0.97 (0.23) (P < 0.01); exercise duration, +103.7 (37.6) sec (P < 0.001); and maximal oxygen uptake, +2.48 (1.76) ml/kg(.)min (P < 0.01)]. Subgroup analysis and meta-regression showed significant relationships between the IGF-I response and GH treatment effects.Conclusion: Our meta-analysis suggests that GH treatment improves several relevant cardiovascular parameters in patients with CHF. However, these results must be confirmed by a large randomized placebo-controlled trial on hemodynamic, morphological, and functional parameters during long-term high-dose GH treatment of patients with CHF.