Lombardi G, Colao A, Marzullo P, Ferone D, Longobardi S, Esposito V, Merola B
Department of Molecular and Clinical Endocrinology, Federico II University, Naples, Italy.
J Endocrinol. 1997 Oct;155 Suppl 1:S33-7; discussion S39.
At present, there is growing evidence implicating GH and/or IGF-I in the intricate cascade of events connected with the regulation of heart development and hypertrophy. Moreover, GH excess and/or deficiency have been shown to include in their advanced clinical manifestations almost always an impaired cardiac function, which may reduce life expectancy. This finding is related both to a primitive impairment of heart structure and function and to metabolic changes such as hyperlipidemia, increase of body fat and premature atherosclerosis. Patients with childhood or adulthood-onset GH deficiency have a reduced left ventricular mass and ejection fraction and the indexes of left ventricular systolic function remain markedly depressed during exercise. Conversely, in acromegaly the cardiac enlargement, which is disproportionate to the increase in size of other internal body organs, has been a rather uniform finding. The severity of the acromegalic cardiomyopathy was reported to be correlated better with the disease duration than with circulating GH and/or IGF-I levels. Myocardial hypertrophy with interstitial fibrosis, lymphomononuclear infiltration and areas of monocyte necrosis often results in concentric hypertrophy of both ventricles. The treatment of GH deficiency and excess improved cardiac function. Interestingly, based on the evidence that GH increases cardiac mass, recombinant GH was administered to patients with idiopathic dilated cardiomyopathy. It increased the myocardial mass and reduced the size of the left ventricular chamber, resulting in improvement of hemodynamics, myocardial energy metabolism and clinical status. These promising results open new perspectives for the use of GH in heart failure.
目前，越来越多的证据表明生长激素（GH）和/或胰岛素样生长因子-I（IGF-I）参与了与心脏发育和肥大调节相关的复杂事件级联反应。此外，已表明GH分泌过多和/或缺乏在其晚期临床表现中几乎总是包括心脏功能受损，这可能会缩短预期寿命。这一发现既与心脏结构和功能的原发性损害有关，也与代谢变化有关，如高脂血症、体脂增加和过早出现动脉粥样硬化。儿童期或成年期发病的GH缺乏患者左心室质量和射血分数降低，运动期间左心室收缩功能指标仍明显降低。相反，在肢端肥大症中，心脏增大与身体其他内部器官大小的增加不成比例，这是一个相当一致的发现。据报道，肢端肥大性心肌病的严重程度与病程的相关性比与循环中的GH和/或IGF-I水平的相关性更好。心肌肥大伴间质纤维化、淋巴细胞单核细胞浸润和单核细胞坏死区域常导致双心室向心性肥大。GH缺乏和过量的治疗改善了心脏功能。有趣的是，基于GH可增加心脏质量的证据，重组GH被用于特发性扩张型心肌病患者。它增加了心肌质量，减小了左心室腔的大小，从而改善了血流动力学、心肌能量代谢和临床状况。这些有前景的结果为GH在心力衰竭中的应用开辟了新的前景。
