Ike J O, Fervenza F C, Hoffman A R, Yeh I, Hintz R L, Liu F, Rabkin R
Department of Medicine and Pediatrics, Stanford University School of Medicine, California, USA.
Kidney Int. 1997 Mar;51(3):840-9. doi: 10.1038/ki.1997.118.
Short-term high-dose insulin-like growth factor-1 (IGF-1) therapy has been shown to enhance glomerular filtration rate (GFR) in end-stage chronic renal failure (CRF), but the efficacy and safety of prolonged therapy is unproven. To determine if prolonged therapy with IGF-1 can enhance renal function in advanced CRF, eight patients were entered into a study to receive one month of IGF-1 treatment, 60 micrograms/kg subcutaneously b.i.d. Six patients completed the study and two dropped out for reasons considered to be unrelated to the IGF-I treatment. Baseline inulin and PAH clearances averaged 17 +/- 3 and 66 +/- 14 ml/min/1.73 m2, respectively, in the subjects who completed the study. With treatment there was a modest 14% increase in the average GFR which approached statistical significance (P = 0.051). After stopping treatment the clearance values returned to basal values. The PAH clearance showed a similar trend. There were no significant changes in BUN, serum creatinine or electrolyte levels. On the other hand there were marked changes in the serum IGF binding protein (IGFBP) profile. Serum IGFBP-3 levels fell while IGFBP-1 and -2 levels rose during treatment, changes that likely affect the bioavailability of IGF-I. Thus, in this small series of patients IGF-1 treatment produced significant changes in the serum IGFBP profile and a modest upward trend in the GFR.
短期大剂量胰岛素样生长因子-1（IGF-1）治疗已被证明可提高终末期慢性肾衰竭（CRF）患者的肾小球滤过率（GFR），但长期治疗的疗效和安全性尚未得到证实。为了确定IGF-1长期治疗能否改善晚期CRF患者的肾功能，8例患者进入一项研究，接受为期1个月的IGF-1治疗，皮下注射，剂量为60微克/千克，每日2次。6例患者完成了研究，2例因被认为与IGF-1治疗无关的原因退出。完成研究的受试者的基线菊粉清除率和对氨基马尿酸清除率分别平均为17±3和66±14毫升/分钟/1.73平方米。治疗后，平均GFR适度增加了14%，接近统计学显著性（P = 0.051）。停止治疗后，清除率值恢复到基础值。对氨基马尿酸清除率呈现类似趋势。血尿素氮、血清肌酐或电解质水平无显著变化。另一方面，血清IGF结合蛋白（IGFBP）谱有明显变化。治疗期间，血清IGFBP-3水平下降，而IGFBP-1和-2水平上升，这些变化可能会影响IGF-1的生物利用度。因此，在这一小系列患者中，IGF-1治疗使血清IGFBP谱发生了显著变化，GFR出现了适度的上升趋势。
