重组人生长激素治疗充血性心力衰竭

A clinical study of low-dose rhGH in the treatment of congestive heart failure

目的 :探讨重组人生长激素 ( rh GH)治疗充血性心力衰竭对心功能、心室形态和血浆肿瘤坏死因子α( TNFα)的影响。方法 :2 7例重度充血性心力衰竭患者随机分成两组 :1rh GH组 :在强心、利尿、扩血管等常规抗心力衰竭治疗的基础上 ,加用 rh GH;2常规组 :予常规抗心力衰竭治疗。治疗前 ,治疗 1个月和 3个月时 ,以超声心动图测定心功能 ,6min步行试验评定患者的运动能力 ,放射免疫法测定血浆生长激素 ( GH)、TNFα浓度。结果 :完成 rh GH治疗的 11例 ,与完成常规治疗的 9例相比 ,室壁厚度明显增加 ( P <0 .0 5 ) ,心腔明显缩小 ( P <0 .0 1) ,TNFα显著降低 ( P <0 .0 5 ) ,心功能好转和运动耐量的提高较常规治疗更显著 ( P <0 .0 1)。结论 :与常规抗心力衰竭治疗相比 ,rh

Objective:To examine the effects of low dose rhGH on left ventricular structure and functions, and TNFα levels in patients with congestive heart failure.Method:Twenty patients with severe congestive heart failure of dilated cardiomyopathy or ischemic cardiomyopathy were randomily divided into two groups:the conventionally treated group and the rhGH group. The later was treated with rhGH additionally. All patients were studied at baseline, after 1 month and 3 months of therapy. Heart function was assessed by echocardiography and 6 minutes walking test. Tumor necrosis factor (TNF) and growth hormone (GH) were measured by radioimmunoassay.Result: At the baseline, plasma levels of GH and TNFα were significantly higher in heart failure patients than those in normal subjects (P< 0.05 ). Compared with those in the conventionally treated group, patients in the rhGH group performed longer 6 minute walking distance (P< 0.01 ), and had increased left ventricular wall thickness (P< 0.05 ), more reduced chamber size (P< 0.01 ) and TNFα level (P< 0.05 ).The change of TNFα level was significantly correlated to its baseline level (r= 0.81 , P= 0.0025 ).Conclusion:In congestive heart failure, there are increases of GH and TNFα levels.The administration of recombinant human GH to patients with congestive heart failure may increase the left ventricular wall thickness and reduce the chamber size and TNFα level, resulting in improvement in cardiac function and exercise capacity more than those with conventional therapy.