Minuto F, Barreca A, Melioli G
Chair of Endocrinology, DiSEM, University of Genova, Italy.
J Endocrinol Invest. 2003 Sep;26(9):919-23. doi: 10.1007/BF03345244.
Besides anabolic steroids, the most common performance-enhancing hormones are erythropoietin (EPO), insulin, GH, and gonadotropins, mostly indistinguishable from endogenous hormones and with very short half-life. This makes virtually impossible to demonstrate their use by measuring their concentration in the blood or urine. A possible approach to the problem may lie in in-direct demonstration through detection of the biological effects of these substances. The finding of an increased hematocrit level is suspicious but not clearly demonstrative of EPO abuse. Very high levels of circulating EPO could be associated with a strong suspicion of doping, when associated to other abnormal parameters, such as Ht, sTFRr, EPO, RDW. The presence of antibodies against the polysaccharide fraction of lateral chains of EPO has been observed only in patients treated with rhEPO. Owing to the pulsatile pattern of GH, particularly during physical exercise, pathologically high values may be found in normal subjects. Therefore, as in the case of EPO, evidence of GH abuse can be gathered only indirectly by detecting the biological effects of its administration. In training subjects GH treatment increased GH, IGF-I, IGFBP-3 and ALS, and decreased IGBP-2. After cessation of treatment IGF-I, IGFBP-3 and ALS approached basal values between 49 and 96 h. Also the bone parameters PICP ICIP, PIUP and osteocalcin increased significantly. Four days after cessation of treatment, levels of PIIIP and ICTP were still abnormally elevated. In conclusion, increases in IGF-I, IGFBP-3, ALS, PIIIP and ICTP are all indicative of recent GH abuse or of acromegaly.
除了合成代谢类固醇外，最常见的提高运动成绩的激素是促红细胞生成素（EPO）、胰岛素、生长激素（GH）和促性腺激素，这些激素大多与内源性激素难以区分，且半衰期很短。这使得通过测量血液或尿液中的浓度来证明它们的使用几乎不可能。解决这个问题的一种可能方法可能在于通过检测这些物质的生物学效应进行间接证明。血细胞比容水平升高的发现令人怀疑，但并不能明确证明存在EPO滥用。当与其他异常参数（如Ht、sTFRr、EPO、RDW）相关联时，循环EPO水平非常高可能强烈怀疑存在兴奋剂使用。仅在接受重组人促红细胞生成素（rhEPO）治疗的患者中观察到针对EPO侧链多糖部分的抗体。由于生长激素的脉冲式分泌模式，特别是在体育锻炼期间，正常受试者可能会出现病理性高值。因此，与EPO的情况一样，只能通过检测其给药的生物学效应来间接收集生长激素滥用的证据。在训练受试者中，生长激素治疗会使生长激素、胰岛素样生长因子-I（IGF-I）、胰岛素样生长因子结合蛋白-3（IGFBP-3）和酸性不稳定亚基（ALS）升高，而使胰岛素样生长因子结合蛋白-2（IGBP-2）降低。治疗停止后，IGF-I、IGFBP-3和ALS在49至96小时内接近基础值。骨参数I型前胶原羧基端前肽（PICP）、I型胶原交联羧基端肽（ICIP）、I型胶原交联氨基端肽（PIUP）和骨钙素也显著增加。治疗停止四天后，III型前胶原氨基端肽（PIIIP）和I型胶原交联羧基端肽（ICTP）水平仍异常升高。总之，IGF-I、IGFBP-3、ALS、PIIIP和ICTP的升高均表明近期存在生长激素滥用或肢端肥大症。
