[垂体功能正常且伴有双心室心力衰竭和肝淤血患者生长激素/胰岛素样生长因子-1轴的变化]

[Changes in growth hormone/insulin-like growth factor-1 axis in patients with normal pituitary function and biventricular cardiac failure and hepatic stasis].

作者信息

Mangieri E, Tosti-Croce C, Tanzilli G, Barillà F, Nardi M, Poggi M, Ciavolella M, Farinelli A, Mangiaracina F, Campa P P

机构信息

II Cattedra di Cardiologia, Università degli Studi La Sapienza, Roma.

出版信息

Cardiologia. 1996 May;41(5):449-53.

PMID:8767634

Abstract

Previous studies showed increased growth hormone (GH) plasma levels in patients with severe heart failure. It has been hypothesized that the activation of adenohypophysis determines the enhanced release of GH. The present study was designed to verify whether impaired hepatic function, due to biventricular cardiac failure and hepatic stasis, by reducing synthesis and release of insulin-like growth factor-1 (IGF-1), may affect the negative feedback mechanism of the IGF-1 on GH secretion. We studied 20 normotensive, non diabetic patients without primitive liver disease; 10 patients in NYHA functional class IV with clinical signs of biventricular cardiac impairment and hepatic stasis (Group A); 10 patients in NYHA functional class III with prevalent left ventricular dysfunction (Group B). Blood samples for radioimmunologic determination of GH, IGF-1, atrial natriuretic factor (ANF), proteins, albumin plasma levels and transaminase plasma levels measurements, were collected 24 hours before hemodynamic study. Group A patients had clinical and hemodynamic signs of hepatic stasis with impaired liver function (SGOT 68 +/- 5.5 U/l; SGPT 89 +/- 4.3 U/1; proteins 4.56 +/- 0.4 g/dl with albumin/globulin ratio < 1; albumin plasma levels 2.8 +/- 0.7 g/dl). The parameters were normal in Group B (SGOT 16 +/- 3.7 U/l;SGPT 13 +/- 1.9 U/l; proteins 7.5 +/- 0.7 g/dl with albumin/globulin ratio > or = 1.5;albumin plasma levels 4.2 +/- 1.2 g/dl). ANF values, over normal range in both groups, were significantly higher in Group A (157.9 +/- 43.9 vs 65.6 +/- 14.6 fmol/ml.p < 0.0001). In Group A GH values were increased (4.9 +/- 4.5 vs 0.12 +/- 0.04 ng/ml); on the contrary IGF-1 values were lower (187.9 +/- 98.2 vs 260.4 +/- 141.4 ng/ml, p < 0.01). The comparison between IGF-1 and albumin plasma levels showed a high correlation either in Group A (r = 0.88, p < 0.001;) or in Group B (r = 0.81, p < 0.001). Our findings allow to hypothesize that the reduced hepatic synthesis and release of IGF-1 may be responsible for the lack of trophic action of GH on cardiac myocytes in patients with biventricular heart failure and hepatic stasis.

摘要

以往研究表明，重度心力衰竭患者血浆生长激素（GH）水平升高。据推测，腺垂体的激活决定了GH释放的增加。本研究旨在验证因双心室心力衰竭和肝淤血导致的肝功能受损，通过降低胰岛素样生长因子-1（IGF-1）的合成和释放，是否会影响IGF-1对GH分泌的负反馈机制。我们研究了20名血压正常、无原发性肝脏疾病的非糖尿病患者；10名纽约心脏协会（NYHA）心功能IV级、有双心室心脏损害和肝淤血临床体征的患者（A组）；10名NYHA心功能III级、以左心室功能障碍为主的患者（B组）。在进行血流动力学研究前24小时采集血样，用于放射免疫法测定GH、IGF-1、心房利钠因子（ANF）、蛋白质、血浆白蛋白水平以及血浆转氨酶水平。A组患者有肝淤血的临床和血流动力学体征，且肝功能受损（谷草转氨酶68±5.5 U/l；谷丙转氨酶89±4.3 U/1；蛋白质4.56±0.4 g/dl，白蛋白/球蛋白比值<1；血浆白蛋白水平2.8±0.7 g/dl）。B组各项参数正常（谷草转氨酶16±3.7 U/l；谷丙转氨酶13±1.9 U/l；蛋白质7.5±0.7 g/dl，白蛋白/球蛋白比值≥1.5；血浆白蛋白水平4.2±1.2 g/dl）。两组ANF值均高于正常范围，且A组显著高于B组（157.9±43.9 vs 65.6±14.6 fmol/ml，p<0.0001）。A组GH值升高（4.9±4.5 vs 0.12±0.04 ng/ml）；相反，IGF-1值较低（187.9±98.2 vs 260.4±141.4 ng/ml，p<0.01）。A组和B组中IGF-1与血浆白蛋白水平的比较均显示出高度相关性（A组：r = 0.88，p<0.001；B组：r = 0.81，p<0.001）。我们的研究结果提示，双心室心力衰竭和肝淤血患者肝脏IGF-1合成和释放减少，可能是GH对心肌细胞缺乏营养作用的原因。