Lombardi G, Colao A, Cuocolo A, Longobardi S, Di Somma C, Orio F, Merola B, Nicolai E, Salvatore M
Department of Endocrinology and Clinical and Molecular Oncology, Federico II University, Naples, Italy.
J Pediatr Endocrinol Metab. 1997 Nov-Dec;10(6):553-60. doi: 10.1515/jpem.1997.10.6.553.
In recent years it has been demonstrated that both GH deficiency and excess include in their advanced clinical manifestations an impaired cardiovascular function, which may reduce life expectancy. This observation has allowed the investigation of the role played by the GH/IGF-I axis on cardiac structure and function. In particular, several recent experimental and clinical studies support the evidence implicating GH and/or IGF-I in the regulation of heart development. Acromegalic cardiomyopathy is characterized by myocardial hypertrophy with interstitial fibrosis, lymphomononuclear infiltration and areas of monocyte necrosis which often result in increased right and left ventricular mass and concentric hypertrophy. Conversely, patients with childhood or adulthood-onset GH deficiency (GHD) have a reduced left ventricular mass and ejection fraction and the indexes of left ventricular systolic function remained markedly depressed during exercise. In addition, a significant increase in the thickness of the vascular intima-media wall and a higher number of atheromatous plaques have been reported. These abnormalities of the cardiovascular system are partially reversed after normalization of GH and IGF-I levels, by octreotide in acromegaly or after GH replacement therapy in GHD patients. The evidence that GH is able to increase cardiac mass suggested its use in the treatment of idiopathic dilated cardiomyopathy. In a recent study on such patients, the administration of rhGH was demonstrated to increase myocardial mass and to reduce the size of the left ventricular chamber, resulting in an improvement in hemodynamics, myocardial energy metabolism and clinical status. These promising results might open a new field for GH treatment.
近年来，已有研究表明，生长激素（GH）缺乏和过量在其晚期临床表现中均包括心血管功能受损，这可能会缩短预期寿命。这一观察结果使得人们能够研究GH/胰岛素样生长因子-I（IGF-I）轴在心脏结构和功能中所起的作用。特别是，最近的一些实验和临床研究支持了GH和/或IGF-I参与心脏发育调节的证据。肢端肥大症性心肌病的特征是心肌肥大，伴有间质纤维化、淋巴细胞单核细胞浸润和单核细胞坏死区域，这通常会导致左右心室质量增加和向心性肥大。相反，儿童期或成年期起病的生长激素缺乏症（GHD）患者的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。此外，有报道称血管内膜中层壁厚度显著增加，动脉粥样斑块数量增多。在肢端肥大症患者中，通过奥曲肽使GH和IGF-I水平正常化，或在GHD患者中进行GH替代治疗后，心血管系统的这些异常情况会部分得到逆转。GH能够增加心脏质量这一证据表明其可用于治疗特发性扩张型心肌病。在最近一项针对此类患者的研究中，已证明给予重组人生长激素（rhGH）可增加心肌质量并减小左心室腔大小，从而改善血流动力学、心肌能量代谢和临床状况。这些有前景的结果可能为GH治疗开辟一个新领域。
