Flyvbjerg A
Medical Department M (Endocrinology and Diabetes), Aarhus Kommunehospital, Denmark.
Kidney Int Suppl. 1997 Sep;60:S12-9.
This review has updated recent facets of evidence for the significance of the GH/IGF system in the development of diabetic kidney disease. It seems evident, however, that there is still an extensive number of questions that need to be answered before diabetic kidney disease is fully understood. The knowledge we have today indicates that GH/IGF axis, through a complex system comprising GHR, GHBP, IGFs, IGF receptors and IGFBPs may be responsible for both early and late renal changes in experimental diabetes (Fig. 3). In view of the complexity of the GH/IGF system, it will be a challenge to fully characterize the renal effects of GH/IGFs in diabetic kidney disease. There is no doubt that information on this topic will occur with increasing pace in the near future and that a understanding of the above-mentioned mechanisms will allow the further development of existing antagonists and design of new drugs, which may prove to be useful for therapeutic manipulation in the treatment of diabetic nephropathy. The development of long-acting somatostatin analogues and GH antagonists, both with a specific action on the GH/IGF axis, seems to be one important step ahead. The combined administration of one of these antagonists with other drugs with a well described renoprotective action (such as ACE inhibitors) opens an interesting new dimension.
本综述更新了生长激素/胰岛素样生长因子（GH/IGF）系统在糖尿病肾病发生发展中重要性的近期证据方面。然而，显而易见的是，在糖尿病肾病被完全理解之前，仍有大量问题需要解答。我们目前所掌握的知识表明，GH/IGF轴通过一个由生长激素受体（GHR）、生长激素结合蛋白（GHBP）、胰岛素样生长因子（IGFs）、IGF受体和IGF结合蛋白（IGFBPs）组成的复杂系统，可能对实验性糖尿病早期和晚期的肾脏变化均有影响（图3）。鉴于GH/IGF系统的复杂性，全面描述GH/IGFs在糖尿病肾病中的肾脏效应将是一项挑战。毫无疑问，关于这一主题的信息在不久的将来会越来越多，并且对上述机制的理解将有助于现有拮抗剂的进一步研发以及新药的设计，这可能被证明对糖尿病肾病的治疗性干预有用。长效生长抑素类似物和GH拮抗剂的研发，两者均对GH/IGF轴有特异性作用，似乎是向前迈出的重要一步。将这些拮抗剂之一与其他具有明确肾脏保护作用的药物（如血管紧张素转换酶抑制剂）联合使用，开启了一个有趣的新领域。
