Jones Kim D, Deodhar Parimal, Lorentzen Ashley, Bennett Robert M, Deodhar Atul A
Division of Arthritis & Rheumatic Diseases, School of Medicine, Oregon Health & Science University School of Nursing, 3455 SW U.S. Veterans Hospital Road, Portland, OR 97239, USA.
Semin Arthritis Rheum. 2007 Jun;36(6):357-79. doi: 10.1016/j.semarthrit.2006.09.006. Epub 2007 Jan 16.
Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain, fatigue, disrupted sleep, depression, and physical deconditioning. In this article, we review the literature on the normal activity of the hypothalamic-pituitary-growth hormone-insulin-like growth factor-1 (HP-GH-IGF-1) axis and its perturbations in FM subjects.
Studies included in this review were accessed through an English language search of Cochrane Collaboration Reviews. Keyword MeSH terms included "fibromyalgia," "growth hormone" (GH), or "insulin-like growth factor-1" (IGF-1).
Twenty-six studies enrolling 2006 subjects were reviewed. Overall, low levels of IGF-1 were found in a subgroup of subjects. Growth hormone stimulation tests often revealed a suboptimal response, which did not always correlate with IGF-1 levels. No consistent defects in pituitary function were found. Of the 3 randomized placebo controlled studies, only 9 months of daily injectable recombinant GH reduced FM symptoms and normalized IGF-1.
These studies suggest that pituitary function is normal in FM and that reported changes in the HP-GH-IGF-1 axis are most likely hypothalamic in origin. The therapeutic efficacy of supplemental GH therapy in FM requires further study before any solid recommendations can be made.
纤维肌痛（FM）是一种以慢性广泛性疼痛、疲劳、睡眠紊乱、抑郁和身体机能失调为特征的综合征。在本文中，我们综述了关于下丘脑 - 垂体 - 生长激素 - 胰岛素样生长因子 -1（HP - GH - IGF -1）轴的正常活动及其在FM患者中的紊乱情况的文献。
本综述纳入的研究通过对Cochrane协作网综述进行英文检索获得。关键词医学主题词包括“纤维肌痛”、“生长激素”（GH）或“胰岛素样生长因子 -1”（IGF -1）。
对纳入2006名受试者的26项研究进行了综述。总体而言，在一部分受试者中发现IGF -1水平较低。生长激素刺激试验常常显示反应欠佳，且这并不总是与IGF -1水平相关。未发现垂体功能存在一致的缺陷。在3项随机安慰剂对照研究中，只有每日注射重组GH持续9个月可减轻FM症状并使IGF -1恢复正常。
这些研究表明FM患者的垂体功能正常，并且所报道的HP - GH - IGF -1轴的变化很可能源于下丘脑。在能够给出任何可靠建议之前，补充GH疗法在FM中的治疗效果需要进一步研究。
