生长激素对慢性心力衰竭患者运动能力和心肺功能的影响。

Effects of growth hormone on exercise capacity and cardiopulmonary performance in patients with chronic heart failure.

作者信息

Fazio Serafino, Palmieri Emiliano A, Affuso Flora, Cittadini Antonio, Castellano Graziella, Russo Teresa, Ruvolo Antonio, Napoli Raffaele, Saccà Luigi

机构信息

Department of Internal Medicine, Cardiovascular and Immunological Sciences, University Federico II School of Medicine, 80131 Naples, Italy.

出版信息

J Clin Endocrinol Metab. 2007 Nov;92(11):4218-23. doi: 10.1210/jc.2007-1189. Epub 2007 Aug 14.

DOI:10.1210/jc.2007-1189

PMID:17698902

Abstract

BACKGROUND

Because GH exerted beneficial effects in various experimental models of heart failure, we investigated the effects of GH on physical exercise capacity and cardiopulmonary performance in patients with dilated cardiomyopathy and chronic heart failure (CHF).

METHODS

Twenty-two patients with CHF (New York Heart Association functional class II-III) underwent spirometry and a symptom-limited, cardiopulmonary exercise testing before and after 3 months of GH (n = 11; seven males; seven idiopathic; 57 +/- 11 yr; 4 IU sc every other day) or placebo (n = 11; eight males; six idiopathic; 54 +/- 10 yr) administration, in a randomized, double-blind trial. Background CHF therapy remained unchanged.

RESULTS

GH, but not placebo, increased IGF-I serum concentration (from 144 +/- 35 to 293 +/- 58 ng/ml; P < 0.005) and improved New York Heart Association functional class (from 2.4 +/- 0.5 to 1.8 +/- 0.4; P < 0.005), exercise duration (from 831 +/- 273 to 925 +/- 266 sec; P < 0.005), peak power output (from 245 +/- 127 to 280 +/- 132 W; P < 0.05), peak minute ventilation (from 52.5 +/- 16.1 to 61.3 +/- 17.3 liters/min; P < 0.05), peak oxygen consumption (from 19.8 +/- 5.6 to 25.1 +/- 5.6 ml/kg.min; P < 0.005), and anaerobic threshold (from 14.9 +/- 4.8 to 20.0 +/- 4.5 ml/kg.min; P < 0.005) without affecting lung function parameters. Furthermore, the slope of the relationship between minute ventilation and pulmonary carbon dioxide production (ventilatory efficiency) decreased from 34.7 +/- 5.1 to 31.7 +/- 5.3 (P < 0.005), whereas the slope of the relation between percent predicted heart rate reserve used and percent observed metabolic reserve used (chronotropic index) rose from 0.57 +/- 0.20 to 0.69 +/- 0.18 (P < 0.005).

CONCLUSION

Given the predictive value of physical exercise capacity and cardiopulmonary performance in CHF progression, these data provide additional insights into the mechanisms by which GH may potentially benefit CHF patients.

摘要

背景

由于生长激素（GH）在各种心力衰竭实验模型中发挥了有益作用，我们研究了GH对扩张型心肌病和慢性心力衰竭（CHF）患者体育锻炼能力和心肺功能的影响。

方法

在一项随机双盲试验中，22例CHF患者（纽约心脏协会心功能II - III级）在接受3个月的GH（n = 11；7名男性；7例特发性；57±11岁；隔日皮下注射4 IU）或安慰剂（n = 11；8名男性；6例特发性；54±10岁）治疗前后，进行了肺活量测定和症状限制性心肺运动试验。CHF的背景治疗保持不变。

结果

GH治疗组而非安慰剂组，血清胰岛素样生长因子 - I（IGF - I）浓度升高（从144±35 ng/ml升至293±58 ng/ml；P < 0.005），纽约心脏协会心功能分级改善（从2.4±0.5降至1.8±0.4；P < 0.005），运动持续时间延长（从831±273秒增至925±266秒；P < 0.005），峰值功率输出增加（从245±127瓦增至280±132瓦；P < 0.05），峰值分钟通气量增加（从52.5±16.1升/分钟增至61.3±17.3升/分钟；P < 0.05），峰值耗氧量增加（从19.8±5.6毫升/千克·分钟增至25.1±5.6毫升/千克·分钟；P < 0.005），无氧阈值提高（从14.9±4.8毫升/千克·分钟增至20.0±4.5毫升/千克·分钟；P < 0.005），且未影响肺功能参数。此外，分钟通气量与肺二氧化碳产生量之间关系的斜率（通气效率）从34.7±5.1降至31.7±5.3（P < 0.005），而预测心率储备使用百分比与观察到的代谢储备使用百分比之间关系的斜率（变时指数）从0.57±0.20升至0.69±0.18（P < 0.005）。