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[用促甲状腺素释放激素类似物抑制垂体生长激素分泌对糖尿病性视网膜病进行试验性治疗]

[Trial treatment of diabetic retinopathy by inhibition of pituitary somatotropin secretion with MAP].

作者信息

Bruni B, Bruni-Bocher K, Della Valle A, Gamba S

出版信息

Minerva Med. 1975 Mar 21;66(21):1001-23.

PMID:1124148
Abstract

The recent literature relating to the pathogenesis of diabetic retinopathy, with or without nephropaty, is critically reviewed. Particular attention is given to the Growth Hormone (GH) hypothesis. The various procedures of hypophysectomy are discussed, including the possible ways of suppressing growth hormone production or overproduction by drugs, and expecially by medroxyprogesterone acetate (MAP). Personal results obtained with long-term administration of MAP in deposit form on alternate days in 10 patients with advanced retinopathy are described. An icostant and rely significant suppression of the GH response to insulin-induced hypoglicemia was noted in 6 cases, showing that a complete pituitary inactivation had been achieved. Therefore, the modifications observed in the fundus picture (studied with retinal photographs according to the Hammersmith Hospital Standards) seem to have no relationship with such a condition. The features involved were Microaneurysms and Haemorrhages (HAEMS) and Exudates (EX);New Vessels (NV) and Retinitis Proliferans (RP) were unaffected. Subjective improvement is visual acuity appeared to be more frequent, with various possible explanations. MAP was without appreciable effect on the clinical and metabolic course of the diabetes, or on renal function in cases of concomitant nephropathy. In the light of these preliminary results, further investigations might seem to be justified.

摘要

对近期有关糖尿病视网膜病变(无论有无肾病)发病机制的文献进行了批判性综述。特别关注生长激素(GH)假说。讨论了垂体切除术的各种方法,包括通过药物,尤其是醋酸甲羟孕酮(MAP)抑制生长激素产生或过量产生的可能方式。描述了对10例晚期视网膜病变患者隔日以沉积形式长期给予MAP所获得的个人结果。在6例患者中观察到对胰岛素诱导的低血糖的GH反应持续且显著受到抑制,表明已实现垂体完全失活。因此,眼底图像(根据哈默史密斯医院标准用视网膜照片研究)中观察到的改变似乎与这种情况无关。所涉及的特征是微动脉瘤和出血(HAEMS)以及渗出物(EX);新生血管(NV)和增殖性视网膜病变(RP)未受影响。视力主观改善似乎更常见,有各种可能的解释。MAP对糖尿病的临床和代谢过程或合并肾病患者的肾功能没有明显影响。鉴于这些初步结果,进一步的研究似乎是合理的。

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