Johannsson G, Bengtsson B A, Andersson B, Isgaard J, Caidahl K
Research Centre for Endocrinology and Metabolism, Sahlgrenska University Hospital, Göteborg, Sweden.
Clin Endocrinol (Oxf). 1996 Sep;45(3):305-14. doi: 10.1046/j.1365-2265.1996.00820.x.
The long-term cardiovascular effects of GH administration in adults are of major clinical importance, given the increasing use of such treatment. We have evaluated long-term cardiovascular effects of recombinant human GH (rhGH) substitution in GH deficient men.
S.c. rhGH 0.5 U/kg/week or placebo was administered in a 6-month double-blind, cross-over study, followed (after a year without substitution) by a 42-month period of open GH substitution.
We evaluated 7 GH-deficient men serially and compared the results with 21 men matched in terms of age and height.
Investigations included exercise tests and Doppler-echocardiography to determine exercise capacity and cardiovascular performance.
Heart rate and systolic blood pressure at rest increased with GH substitution to the level of the controls, as did diastolic blood pressure after an initial reduction. Age-adjusted exercise capacity increased during the study and we found no evidence of ischaemic heart disease on exercise ECG. Stroke volume increased with GH substitution, thereby normalizing the initially reduced cardiac index. There was no significant change in left atrial or ventricular internal dimensions, systolic function as measured by fractional shortening, or diastolic function as measured by isovolumic relaxation time and left ventricular filling (A/E ratio). However, a lower atrial emptying index than that seen among controls might indicate some diastolic disturbance and there was a definite increase in left ventricular wall thickness compared with controls (to 25.1 +/- 1.5 vs 19.7 +/- 0.4 mm, P < 0.001).
We found that GH substitution in GH-deficient adults had a beneficial effect on physical performance and cardiac output. The concomitant increase in left ventricular mass index might be an effect of an excessive substitution dose.
鉴于生长激素（GH）治疗的使用日益增加，其在成人中的长期心血管影响具有重要的临床意义。我们评估了重组人生长激素（rhGH）替代治疗对生长激素缺乏男性的长期心血管影响。
在一项为期6个月的双盲交叉研究中，皮下注射rhGH 0.5 U/kg/周或安慰剂，随后（在无替代治疗1年后）进行为期42个月的开放生长激素替代治疗。
我们对7名生长激素缺乏男性进行了连续评估，并将结果与21名年龄和身高匹配的男性进行了比较。
检查包括运动试验和多普勒超声心动图，以确定运动能力和心血管功能。
生长激素替代治疗后，静息心率和收缩压升高至对照组水平，初始降低后的舒张压也如此。在研究期间，年龄调整后的运动能力有所提高，并且我们在运动心电图上未发现缺血性心脏病的证据。每搏输出量随着生长激素替代治疗而增加，从而使最初降低的心指数恢复正常。左心房或心室内径、通过缩短分数测量的收缩功能、或通过等容舒张时间和左心室充盈（A/E比值）测量的舒张功能均无显著变化。然而，心房排空指数低于对照组可能表明存在一些舒张功能障碍，并且与对照组相比，左心室壁厚度有明确增加（分别为25.1±1.5 vs 19.7±0.4 mm, P < 0.001）。
我们发现生长激素替代治疗对生长激素缺乏的成年人的身体机能和心输出量有有益影响。左心室质量指数的同时增加可能是替代剂量过高的结果。
