Treatment with growth hormone and insulin-like growth factor-I in critical illness
Treatment with growth hormone and insulin-like growth factor-I in critical illness
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DOI：
10.1053/beem.2001.0162
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发表时间：
2001-12-01
影响因子：
7.4
通讯作者：
Carroll, PV
中科院分区：
文献类型：
--
作者：
Carroll, PV
重组人生长激素和胰岛素样生长因子-I的更广泛的可用性导致了对这些合成代谢肽在各种临床条件下药理学给药的潜在益处的研究，其特征在于分解代谢速率的增加。最初的研究是小型的，通常是不受控制的开放式研究，但最近研究人员集中在更大的，受控的多中心试验。迄今为止的研究包括心力衰竭、脓毒症、烧伤、癌症恶病质、终末期肾衰竭、创伤和艾滋病患者，以及大手术前后的患者。作者一般谨慎地解释了生长激素和胰岛素样生长因子-1单独或联合治疗对净蛋白质平衡、身体成分、健康和表现的积极影响。两项大型、随机、安慰剂对照的欧洲多中心研究最近详细说明了生长激素治疗对重症监护患者的影响。死亡率和发病率的主要增加与生长激素治疗有关。导致死亡率增加的机制仍然知之甚少。这些负面的发现导致生长激素的临床使用减少，并在人类疾病的合成代谢治疗领域的研究活动减少。
The wider availability of recombinant human growth hormone and insulin-like growth factor-I has resulted in an investigation into the potential benefits of the pharmacological administration of these anabolic peptides in a variety of clinical conditions, characterized by an increase in catabolic rate. The initial studies were small, often uncontrolled open investigations, but investigators have more recently concentrated on larger, controlled multi-centre trials. Studies to date have included patients with cardiac failure, sepsis, burns, cancer cachexia, end-stage renal failure, trauma and AIDS, and those prior to or following major surgery. The authors have in general cautiously interpreted positive effects of treatment with growth hormone and insulin-like growth factor-1, either alone or in combination, on net protein balance, body composition, well-being and performance. Two large, randomized, placebo-controlled European multi-centre studies have recently detailed the effects of growth hormone treatment in critically ill intensive care patients. Major increases in mortality and morbidity were associated with growth hormone treatment. The mechanism(s) accounting for the increased mortality remain poorly understood. These negative findings have led to a decrease in the clinical use of growth hormone and in research activity in the area of anabolic treatment in human illness.