Bennett R M, Cook D M, Clark S R, Burckhardt C S, Campbell S M
Department of Medicine, Oregon Health Sciences University, Portland 97201, USA.
J Rheumatol. 1997 Jul;24(7):1384-9.
To investigate the serum levels of insulin-like growth factor-I (IGF-I) in patients with fibromyalgia (FM) compared to healthy controls and patients with other rheumatic diseases, and to explore possible etiologic mechanisms of low IGF-I levels in patients with FM.
Five hundred patients with FM and 152 controls (74 healthy blood donors, 26 myofascial pain patients and 52 patients with other rheumatic diseases) were studied. All had measurements of acid extracted serum IGF-I. A subset of 90 patients with FM were evaluated for clinical features that might explain low IGF-I levels. Twenty-five patients with FM underwent growth hormone (GH) provocation testing with l-dopa and clonidine.
The mean serum IGF-I level in patients with FM was 138 +/- 56 ng/ml and in controls 215 +/- 86 ng/ml (p = 0.00000000001). Low levels of IGF-I were not due to depression, tricyclic medications, nonsteroidal antiinflammatory drugs, poor aerobic conditioning, obesity, or pain level. Patients with focal myofascial pain syndromes had normal IGF-I levels (236 +/- 68), as did most patients with other rheumatic disorders, unless they had concomitant FM. Patients with FM with initially normal levels often had a rapid decline of IGF-I over 1 to 2 years. Most patients with FM with low IGF-I levels failed to secrete GH after stimulation with clonidine and l-dopa.
Many, but not all, patients with FM have low levels of IGF-I that cannot be explained by clinical associations. These results suggest that low IGF-I levels in patients with FM are a secondary phenomenon due to hypothalamic-pituitary-GH axis dysfunction.
与健康对照者及其他风湿性疾病患者相比，研究纤维肌痛（FM）患者血清胰岛素样生长因子-I（IGF-I）水平，并探讨FM患者IGF-I水平降低的可能病因机制。
对500例FM患者和152例对照者（74例健康献血者、26例肌筋膜疼痛患者和52例其他风湿性疾病患者）进行研究。所有患者均检测了酸提取血清IGF-I。对90例FM患者的亚组进行了可能解释IGF-I水平降低的临床特征评估。25例FM患者接受了左旋多巴和可乐定的生长激素（GH）激发试验。
FM患者的平均血清IGF-I水平为138±56 ng/ml，对照者为215±86 ng/ml（p = 0.00000000001）。IGF-I水平降低并非由抑郁、三环类药物、非甾体抗炎药、有氧运动能力差、肥胖或疼痛程度所致。局灶性肌筋膜疼痛综合征患者的IGF-I水平正常（236±68），大多数其他风湿性疾病患者也是如此，除非他们同时患有FM。最初IGF-I水平正常的FM患者在1至2年内IGF-I水平常迅速下降。大多数IGF-I水平低的FM患者在可乐定和左旋多巴刺激后未能分泌GH。
许多（但并非所有）FM患者的IGF-I水平较低，无法用临床相关因素解释。这些结果表明，FM患者IGF-I水平降低是下丘脑-垂体-GH轴功能障碍导致的继发性现象。
