The Newman Centre for Sport and Exercise Research, Newman University College, Birmingham, UK.
Am J Cardiovasc Drugs. 2009;9(6):371-81. doi: 10.2165/11312100-000000000-00000.
Arterial endothelial dysfunction is an early event in the pathogenesis of atherosclerosis and predisposes individuals to the deposition of unstable atherosclerotic plaques. It can also lead to increased arterial stiffness, which is an accepted cause of increased arterial pulse wave velocity (APWV). Endothelial dysfunction is reversed by recombinant human growth hormone (rhGH) therapy in patients with growth hormone (GH) deficiency (GHD), favorably influencing the risk for atherogenesis. Endogenous human growth hormone (hGH), secreted by the anterior pituitary, and levels of insulin-like growth factor-I (IGF-I), produced in response to hGH stimulation of the liver, peak during early adulthood, but decline throughout adulthood. It is suspected that low-grade inflammatory cardiovascular pathophysiologic markers such as homocysteine, nitric oxide, C-reactive protein (CRP), and fibrinogen and plasminogen activator inhibitor along with changes in lipid and glucose metabolism may all contribute to GHD-associated metabolic and cardiovascular complications. These effects are associated with increased APWV, but are attenuated by rhGH therapy in GHD. GH replacement increases IGF-I levels and reduces CRP and large-artery stiffness. Reviews of rhGH in the somatopause have not been overtly favorable. Whereas reviews of rhGH/rhIGF-I combinations in GH resistance are more positive than those for rhGH alone, their combined use in the somatopause is limited. Senescent individuals may benefit from such a combination.
动脉内皮功能障碍是动脉粥样硬化发病机制中的早期事件，使个体易发生不稳定的动脉粥样斑块沉积。它还可能导致动脉僵硬增加，这是动脉脉搏波速度（APWV）增加的公认原因。生长激素（GH）缺乏症（GHD）患者的重组人生长激素（rhGH）治疗可逆转内皮功能障碍，有利于动脉粥样形成的风险。内源性人生长激素（hGH）由垂体前叶分泌，胰岛素样生长因子-I（IGF-I）水平由 hGH 刺激肝脏产生，在成年早期达到峰值，但在整个成年期下降。据推测，低水平的炎症心血管病理生理标志物，如同型半胱氨酸、一氧化氮、C 反应蛋白（CRP）和纤维蛋白原以及纤溶酶原激活物抑制剂，以及脂质和葡萄糖代谢的变化，可能都与 GHD 相关的代谢和心血管并发症有关。这些影响与 APWV 的增加有关，但在 GHD 中通过 rhGH 治疗可以减轻。GH 替代可增加 IGF-I 水平并降低 CRP 和大动脉僵硬。对 somatopause 中 rhGH 的综述并不明显有利。虽然 rhGH/rhIGF-I 联合治疗在 GH 抵抗中的作用比单独使用 rhGH 更为积极，但它们在 somatopause 中的联合使用受到限制。衰老个体可能受益于这种组合。
