Burger Albert G, Monson John P, Colao Anna M, Klibanski Anne
Department of Medicine, University of Geneva, Cologny (Geneva), Switzerland.
Endocr Pract. 2006 Nov-Dec;12(6):682-9. doi: 10.4158/EP.12.6.682.
To review the literature on the increased cardiovascular risk in patients with growth hormone (GH) deficiency and the positive effects of GH replacement.
We analyze the factors that contribute to cardiovascular risk in GH deficiency, including body composition and lipid profile, and summarize GH treatment strategies and results described in the literature.
The prominent clinical finding in patients with GH deficiency is the increased abdominal fat, even in patients with normal weight. Cardiac ejection volume tends to be decreased, and arterial distensibility is diminished. The lipid status is also worsened, accompanied by increased inflammatory markers, such as highly sensitive C-reactive protein. Typically, GH treatment reduces visceral fat and increases muscle mass, changes that diminish cardiovascular risk. Because of direct effects as well as increased hemodynamic performance and increased blood volume, cardiac performance is improved. With GH therapy, total cholesterol and low-density lipoprotein levels decrease by 10% to 20%, and inflammatory markers such as C-reactive protein decline. Carbohydrate metabolism during moderate to long-term treatment is minimally affected, although obese patients with GH deficiency on rare occasion may have hyperglycemia or even diabetes.
The relevance of the beneficial effects of GH on the cardiovascular system is strongly suggested but not fully proved. The results in a large cohort of GH-treated patients (the KIMS or Pharmacia and Upjohn International Metabolic Surveillance database) demonstrated no difference in cardiovascular risk in comparison with that in a control population after a mean of 3 years of treatment.
回顾关于生长激素（GH）缺乏患者心血管风险增加以及GH替代治疗积极效果的文献。
我们分析导致GH缺乏患者心血管风险的因素，包括身体成分和血脂谱，并总结文献中描述的GH治疗策略及结果。
GH缺乏患者的突出临床发现是腹部脂肪增加，即使是体重正常的患者。心脏射血容积往往降低，动脉弹性减退。血脂状况也会恶化，同时伴有炎症标志物增加，如高敏C反应蛋白。通常，GH治疗可减少内脏脂肪并增加肌肉量，这些变化可降低心血管风险。由于直接作用以及血流动力学性能改善和血容量增加，心脏功能得到改善。接受GH治疗后，总胆固醇和低密度脂蛋白水平降低10%至20%，C反应蛋白等炎症标志物下降。中长期治疗期间碳水化合物代谢受影响最小，尽管少数GH缺乏的肥胖患者可能出现高血糖甚至糖尿病。
强烈提示但未充分证明GH对心血管系统有益作用的相关性。在一大群接受GH治疗的患者（KIMS或辉瑞和法玛西亚国际代谢监测数据库）中，平均治疗3年后，与对照人群相比，心血管风险无差异。
