在分解代谢状态下，胰岛素样生长因子-I（IGF-I）水平低常与生长激素（GH）水平升高不相关。

Low IGF-I levels are often uncoupled with elevated GH levels in catabolic conditions.

作者信息

Gianotti L, Broglio F, Aimaretti G, Arvat E, Colombo S, Di Summa M, Gallioli G, Pittoni G, Sardo E, Stella M, Zanello M, Miola C, Ghigo E

机构信息

Dipartimento di Medicina Interna, Università di Torino, Italy.

出版信息

J Endocrinol Invest. 1998 Feb;21(2):115-21. doi: 10.1007/BF03350325.

DOI:10.1007/BF03350325

PMID:9585386

Abstract

Increased GH together with decreased IGF-I levels pointing to peripheral GH insensitivity in critically ill patients have been reported by some but not by other authors. To clarify whether elevated GH levels are coupled with low IGF-I levels in all catabolic conditions, basal GH and IGF-I levels were evaluated in patients with sepsis (SEP, no.=13; age [mean+/-SE]=59.2+/-1.2 yr), trauma (TRA, no.=16; age=42.3+/-3.4 yr), major burn (BUR, no.=26; age=52.8+/-4.2 yr) and post-surgical patients (SUR, no.=11; age=55.0+/-4.7 yr) 72 hours after ICU admission or after cardiac surgery. GH and IGF-I levels were also evaluated in normal subjects (NS, no.=75; age=44.0+/-1.5 yr), in adult hypopituitaric patients with severe GH deficiency (GHD, no.=54; age=44.8+/-2.3 yr), in patients with liver cirrhosis (LC, no.=12; age=50.4+/-2.8 yr) and in patients with anorexia nervosa (AN, no.=19; age=18.7+/-0.8 yr). Basal IGF-I and GH levels in GHD were lower than in NS (68.6+/-6.4 vs 200.9+/-8.7 microg/l and 0.3+/-0.1 vs 1.4+/-0.2 microg/l; p<0.01). On the other hand, AN and LC showed IGF-I levels (70.4+/-9.1 and 52.4+/-10.5 microg/l) similar to those in GHD while GH levels (10.0+/-2.8 and 7.9+/-2.1 microg/l) were higher than those in NS (p<0.01). IGF-I levels in SEP (84.5+/-8.8 microg/l) were similar to those in GHD, AN and LC and lower than those in NS (p<0.01). IGF-I levels in BUR (105.2+/-10.9 microg/l) were lower than in NS (p<0.01) but higher than those in GHD, AN, LC and SEP (p<0.01). On the other hand, in TRA (162.8+/-17.4 microg/l) and SUR (135.0+/-20.7 microg/l) IGF-I levels were lower but not significantly different from those in NS and clearly higher than those in GHD, AN, LC, SEP and BUR. Basal GH levels in SEP (0.6+/-0.2 microg/l), TRA (1.8+/-0.5 microg/l), SUR (2.2+/-0.5 microg/l) and BUR (2.2+/-0.5 microg/l) were similar to those in NS, higher (p<0.05) than those in GHD and lower (p<0.01) than those in AN and LC. In conclusion, our data demonstrate that low IGF-I levels are not always coupled with elevated GH levels in all catabolic conditions. Differently from cirrhotic and anorectic patients, in burned and septic patients GH levels are not elevated in spite of very low IGF-I levels similar to those in panhypopituitaric GHD patients. These findings suggest that in some catabolic conditions peripheral GH insensitivity and somatotrope insufficiency could be concomitantly present.

摘要

一些作者报道，危重症患者中生长激素（GH）水平升高而胰岛素样生长因子-I（IGF-I）水平降低，提示外周GH不敏感，但其他作者未发现此现象。为明确在所有分解代谢状态下GH水平升高是否与IGF-I水平降低相关，我们评估了脓毒症（SEP，n = 13；年龄[均值±标准误]=59.2±1.2岁）、创伤（TRA，n = 16；年龄=42.3±3.4岁）、大面积烧伤（BUR，n = 26；年龄=52.8±4.2岁）患者以及手术后患者（SUR，n = 11；年龄=55.0±4.7岁）在入住重症监护病房（ICU）72小时后或心脏手术后的基础GH和IGF-I水平。同时也评估了正常受试者（NS，n = 75；年龄=44.0±1.5岁）、严重GH缺乏（GHD）的成年垂体功能减退患者（n = 54；年龄=44.8±2.3岁）、肝硬化（LC，n = 12；年龄=50.4±2.8岁）患者以及神经性厌食（AN，n = 19；年龄=18.7±0.8岁）患者的GH和IGF-I水平。GHD患者的基础IGF-I和GH水平低于NS患者（68.6±6.4 vs 200.9±8.7 μg/L以及0.3±0.1 vs 1.4±0.2 μg/L；p<0.01）。另一方面，AN和LC患者的IGF-I水平（70.4±9.1和52.4±10.5 μg/L）与GHD患者相似，而GH水平（10.0±2.8和7.9±2.1 μg/L）高于NS患者（p<0.01）。SEP患者的IGF-I水平（84.5±8.8 μg/L）与GHD、AN和LC患者相似，低于NS患者（p<0.01）。BUR患者的IGF-I水平（105.2±10.9 μg/L）低于NS患者（p<0.01），但高于GHD、AN、LC和SEP患者（p<0.01）。另一方面，TRA患者（162.8±17.4 μg/L）和SUR患者（135.0±20.7 μg/L）的IGF-I水平较低，但与NS患者无显著差异，且明显高于GHD、AN、LC、SEP和BUR患者。SEP（0.6±0.2 μg/L）、TRA（1.8±0.5 μg/L）、SUR（2.2±0.5 μg/L）和BUR（2.2±0.5 μg/L）患者的基础GH水平与NS患者相似，高于GHD患者（p<0.05），低于AN和LC患者（p<0.01）。总之，我们的数据表明，在所有分解代谢状态下，低IGF-I水平并不总是与升高的GH水平相关。与肝硬化和神经性厌食患者不同，烧伤和脓毒症患者尽管IGF-I水平极低，与全垂体功能减退的GHD患者相似，但GH水平并未升高。这些发现提示，在某些分解代谢状态下，外周GH不敏感和生长激素分泌不足可能同时存在。