目的:老年患者用生长激素替代激素仍然是一个有争议的研究课题,在临床实践中很少开始。这种不情愿可能源于对不利影响和作为抗老化剂的不严格使用的担忧。然而,对患有某些急性和慢性疾病的选定患者的有益效果可以证明其在高龄时使用是合理的。本系统综述分析了不同合并症的老年患者GH干预的随机对照研究,以评估两者。有益和有害的影响。
方法:实施了系统的搜索策略,以确定PubMed的相关研究,MEDLINE,科克伦图书馆
方法:65岁以上的参与者,随机对照试验涉及人生长激素(GH)和存在至少一个额外的合并症,独立于有缺陷的促身体轴。
结果:8项符合条件的研究涵盖了各种合并症,包括骨质疏松症,脆弱,慢性心力衰竭,髋部骨折,肌萎缩侧索硬化症和血液透析。结果各不相同,包括身体成分的变化,物理性能,力量,骨矿物质密度,心血管参数,生活质量和住房状况。研究方案在GH应用频率上差异很大(每天,第2天或3次/周),剂量(0.41mg-2.6mg;平均每60kg患者1.3mg)和持续时间(1-12个月;平均7个月)。报告了轻度剂量相关的副作用,除了明显的积极影响,特别是对身体成分的影响,功能,和生活质量。
结论:尽管证据有限,GH治疗可能提供不同的好处,很少有副作用。进一步研究IGF-I依赖性适应症和明确的结果,在老年人中纳入IGF-I依赖性GH滴定是有必要的.
Hormonal substitution with growth hormone in aged patients remains a debated research topic and is rarely initiated in clinical practice. This reluctance may originate from concerns about adverse effects and the uncritical use as an anti-aging agent. Nevertheless, beneficial effects for selected patients suffering from certain acute and chronic illnesses could justify its use at an advanced age. This systematic review analyzes randomized controlled studies of GH interventions in older patients with different comorbidities to assess both, beneficial and harmful effects.
A systematic search strategy was implemented to identify relevant studies from PubMed, MEDLINE, and The Cochrane Library.
participants aged over 65 years, randomized controlled trials involving human growth hormone (GH) and presence of at least one additional comorbidity independent of a flawed somatotropic axis.
The eight eligible studies encompassed various comorbidities including osteoporosis, frailty, chronic heart failure, hip fracture, amyotrophic lateral sclerosis and hemodialysis. Outcomes varied, including changes in body composition, physical performance, strength, bone mineral density, cardiovascular parameters, quality of life and housing situation. Study protocols differed greatly in GH application frequency (daily, 2nd day or 3×/week), doses (0.41 mg-2.6 mg; mean 1.3 mg per 60 kg patient) and duration (1-12 months; mean 7 months). Mild dose-related side effects were reported, alongside noticeable positive impacts particularly on body composition, functionality, and quality of life.
Despite limited evidence, GH treatment might offer diverse benefits with few adverse effects. Further research with IGF-I dependent indication and clear outcomes, incorporating IGF-I dependent GH titration in older adults is warranted.