Savage M O, Dunger D B
Division of Paediatric Endocrinology, St Bartholomew's Hospital, London, U.K.
Diabetes Metab. 1996 Jul;22(4):257-60.
Recombinant insulin-like growth factor-I (IGF) has both anabolic and insulin-like effects. In adolescent insulin-dependent diabetes mellitus (IDDM), the GH/IGF-I axis is abnormal, with elevation of growth hormone (GH) secretion and subnormal IGF-I levels. The elevated GH levels contribute to pubertal insulin resistance, making glycaemic control difficult to achieve. Theoretically, rhIGF-I could replace IGF-1 and lower GH by negative feedback effects, hence improving glycaemic control. Two preliminary studies are described in this paper. In the first study, rhIGF-I 40 micrograms/kg s.c. was given as an adjunct to insulin at 1800 h. RhIGF-I induced a significant fall in mean overnight GH secretion and in the insulin infusion rate required to maintain euglycaemia. In the second study, rhIGF-I was given in a dose of 40 micrograms/kg s.c. for 1 month. The dose of isophane insulin fell during puberty, as did HbA1c. These preliminary studies suggest that rhIGF-I given in conjunction with regular insulin therapy may reverse abnormalities in the GH/IGF-I axis and therefore contribute to improvement of glycaemic control in adolescents with IDDM.
重组胰岛素样生长因子-I（IGF）具有合成代谢和胰岛素样作用。在青少年胰岛素依赖型糖尿病（IDDM）中，生长激素/胰岛素样生长因子-I（GH/IGF-I）轴异常，生长激素（GH）分泌增加而胰岛素样生长因子-I水平低于正常。升高的GH水平导致青春期胰岛素抵抗，使得血糖控制难以实现。理论上，重组人胰岛素样生长因子-I（rhIGF-I）可以替代IGF-1并通过负反馈作用降低GH，从而改善血糖控制。本文描述了两项初步研究。在第一项研究中，于18:00皮下注射rhIGF-I 40微克/千克作为胰岛素的辅助治疗。rhIGF-I使夜间平均GH分泌以及维持血糖正常所需的胰岛素输注速率显著下降。在第二项研究中，皮下注射剂量为40微克/千克的rhIGF-I，持续1个月。青春期期间中效胰岛素剂量下降，糖化血红蛋白（HbA1c）水平也下降。这些初步研究表明，rhIGF-I与常规胰岛素治疗联合使用可能会逆转GH/IGF-I轴的异常，因此有助于改善青少年IDDM患者的血糖控制。
