生长激素对心功能作用的探讨

生长激素对心功能作用的探讨 2010-07-01 叶军 沈永年 黄晓东 李劲松 吴靖川 陈瑞冠 【摘要】 目的 探讨生长激素(GH)对心功能的作用。方法 用平衡法核素心血池显象 技术及运动试验对特发性生长激素缺乏症(IGHD)患者在GH治疗前后进行左心室功能。结 果 67例儿童及青 少年两组患者左心室 总体射血分数(LVEF) 明显低于对照组(分 别 为P,0.05及P,0.01)，青少年组其左心室舒张末期高峰充盈率(PFR)也显著低于对照组(P ,0.05);35例(52.2%)左心室总体收缩或(和)舒张功能降低;29例(47.3%)运动试验后出现 心率、ST段及T波异常。13例心功能异常者接受重组人生长激素(rhGH)治疗6个月后，LVEF 及PFR较治疗前显著提高(分别为P,0.05及P,0.01)。结论 约半数生长激素缺乏症(GHD) 患者在没有GH治疗的情况下，其左心室收缩和舒张功能明显受损，并伴有心肌缺血和劳损。 GH治疗可显著改善GHD患者的心功能。 【关键词】 生长激素 生长激素缺乏症 心功能 放射性核素显像 Effect of growth hormone on cardiac performance YE Jun,SHEN Yongnian,HUANG Xiaodong,et al. Shanghai Institute for Pediatric Research,Shanghai,200092 【Abstract】 Objective To evaluate the effect of growth hormone(GH) on cardiac function. Methods Cardiac performance was investigated by equilibrium radionuclide angiography and exercise tolerance test before and after GH treatment in 67 patients with idiopathic growth hormone deficiency(IGHD) and in 10 healthy children. Results The total ejection fraction of left ventricle (LVEF) was greatly reduced in the 67 childhood and adolescent patients (P,0.05 and P,0.01 respectively) and the peak filling rate(PFR) in the end-diastolic phase were remarkably reduced in the adolescent group (P,0.05) as compared with the control group; The total systolic and/or diastolic function of left ventricle was significantly decreased in 35 (52.2%) IGHD patients. Moreover, 29 of 60 (47.3%) patients were found to have abnormal heart rate, depressed ST segment and changed T wave in electrocardiogram profiles after exercise tolerance test. On the other hand, 13 patients with abnormal cardiac function had been treated with recombinant human growth hormone (rhGH) for 6 months and their systolic and diastolic functions of left ventricle were significantly improved (P,0.05 and P,0.01 respectively). Conclusions About half of the patients with primary GHD, who have not been treated with rhGH, had an impaired left ventricle function. GH treatment remarkably improved cardiac performance in these patients. 【Key words】Growth hormone Growth hormone deficiency Cardiac function Radionuclide imaging (Chin J Endocrinol Metab, 1999,15:12-14) 近年来，随着人工合成生长激素(GH)在临床上的 对象和方法 一、对象 我所门诊长期随访的67例(男53，女14)IGHD患者，初诊时已排除引起矮小的继发因素。经定期测量身高，每年身高增长速率,4cm。两种药物GH激发试验测得GH峰值均,10μg/L，结合临床诊断为IGHD。所有患者近3年未用人生长激素治疗。根据年龄，分为两组(儿童组与青少年组);39例青少年组中14例已青春发育(2例女性患者乳房发育进入Tanner 3,4期，12例男性患者睾丸,4ml)，另25例均未达性发育。67例患者中12例在初诊时检测血T4水平低于60μg/L，曾接受甲状腺片替代治疗，本次随访时，所有患者甲状腺、肾上腺皮质功能均正常。选择10名正常健康者(5名儿童，5名青少年)作为心功能检测对照组。临床资料详见1。所有患者无任何心血管方面的症状和体征。 表1 两组GHD患者及对照组临床资料 Tab 1 Clinical characteristics of GHD and control subjects 分组 Group 例数 n 实足年龄(岁) Chronological age (yrs) 身高龄(岁)Height age(yrs) 骨龄(岁) Bone age(yrs) 身高落后SD HSD 生长速率 (厘米/年)Growth rate(cm/yr) 儿童组Childhood 28 7.9?2.3 4.2?1.5 4.3?2.0 3.8?1.1 3.0?1.1 青少年组Adolescent 39 18.7?4.3 10.7?3.0 12.2?4.0 4.2?2.0 2.1?1.4 对照组 Control 10 10.5?2.5 10.2?2.0 9.8?2.3 0.32?1.1 6.0?1.1 注:身高落后SD:身高低于同年龄同性别正常人平均身高的标准差数 HSD:Number of standard deviation below normal average height 二、方法 1.所有患者及对照组均作下列检查:(1)平衡法放射性核素心血池显像左心室功能检测:患者在静息状态下分别静脉注射一定剂量的亚锡焦磷酸盐和高锝酸盐以标记红细胞，在体内平衡后，借助门电路控制，以γ照相机采集心室收缩至舒张期一些血液动力学参数，包括:a.左心室总体射血分数(LVEF)以代表左心室总体收缩功能;同时测定心室侧壁(LAT)、下壁(INF)、心尖(APICAL)、下间壁(INF-SEP)局部射血分数(EF)以代表左心室局部收缩功能。b.左心室舒张末期高峰充盈率(PFR)以代表左心室舒张功能。(2)运动试验:在安静状态下先作EKG检查，然后让患者上下楼梯运动直至心率增加运动前心率的50%以上，再用EKG检测运动后2,8分钟心率、ST段及T波变化。如运动后