Caicedo Diego, Devesa Pablo, Arce Víctor M, Requena Julia, Devesa Jesús
Department of Angiology and Vascular Surgery, Complexo Hospitalario Universitario de Pontevedra, Avda. de Mourente, s/n; 36071-Pontevedra, Spain.
Scientific Direction, Medical Center Foltra. Travesía Montouto, 24; 15710-Teo, A Coruña, 15886, Spain.
Ther Adv Cardiovasc Dis. 2018 Feb;12(2):53-72. doi: 10.1177/1753944717745494. Epub 2017 Dec 22.
Revascularization for chronic limb-threatening ischemia (CLTI) is necessary to alleviate symptoms and wound healing. When it fails or is not possible, there are few alternatives to avoid limb amputation in these patients. Although experimental studies with stem cells and growth factors have shown promise, clinical trials have demonstrated inconsistent results because CLTI patients generally need arteriogenesis rather than angiogenesis. Moreover, in addition to the perfusion of the limb, there is the need to improve the neuropathic response for wound healing, especially in diabetic patients. Growth hormone (GH) is a pleiotropic hormone capable of boosting the aforementioned processes and adds special benefits for the redox balance. This hormone has the potential to mitigate symptoms in ischemic patients with no other options and improves the cardiovascular complications associated with the disease. Here, we discuss the pros and cons of using GH in such patients, focus on its effects on peripheral arteries, and analyze the possible benefits of treating CLTI with this hormone.
对于慢性肢体威胁性缺血(CLTI)患者,血管重建对于缓解症状和促进伤口愈合是必要的。当血管重建失败或无法进行时,在这些患者中几乎没有其他方法可以避免肢体截肢。尽管对干细胞和生长因子的实验研究显示出了前景,但临床试验结果并不一致,因为CLTI患者通常需要动脉生成而非血管生成。此外,除了肢体灌注外,还需要改善神经病变反应以促进伤口愈合,尤其是在糖尿病患者中。生长激素(GH)是一种多效性激素,可以促进上述过程,并且对氧化还原平衡有特殊益处。这种激素有可能减轻没有其他选择的缺血患者的症状,并改善与该疾病相关的心血管并发症。在此,我们讨论在这类患者中使用GH的利弊,重点关注其对外周动脉的影响,并分析用这种激素治疗CLTI的潜在益处。