重组人生长激素对烧伤后高代谢反应的调节作用  

Modulation Effects of Recombinant Human Growth Hormone on Postburn Hypermetabolism in Burn Patients

作　　者：高志刚[1] 刘群[1] 谢宇钢 王玉莲[1] 邓诗琳[1] 

机构地区：[1]天津市第四医院烧伤科,300222

出　　处：《中华烧伤杂志》2004年第3期158-160,共3页Chinese Journal of Burns

摘　　要：目的　探讨重组人生长激素 (rhGH)对烧伤后高代谢反应的作用及其机制。　 方法　选择 1998～ 2 0 0 2年笔者单位收治的烧伤面积为 5 0 %～ 90 %TBSA的患者 32例 ,随机分为治疗组 (A组 ,16例 )和对照组 (B组 ,16例 ) ,治疗组伤后 7d开始皮下注射rhGH,用量 0 .2 5U·kg-1·d-1;对照组于相同时相点注射等量等渗盐水。观察注射后两组患者的静息能量消耗 (REE)、非蛋白呼吸商(NPRQ)、糖代谢、氮平衡、内分泌激素及炎症介质水平变化。　 结果　A组NPRQ于伤后 7d开始增高 ,到 2 1d为 0 .80± 0 .0 9;血浆前列腺素E2 、血栓素B2 、肿瘤坏死因子α、白细胞介素 6显著降低 ;胰岛素、生长激素 (GH)、胰岛素样生长因子Ⅰ (IGF Ⅰ)显著升高 ,伤后累积氮丢失明显低于B组。A组肾上腺素、皮质醇、胰高血糖素明显高于B组 (P <0.0 5 )。　 结论　伤后适时应用rhGH可调节严重烧伤患者的高代谢反应 ;通过增加机体GH、IGF Ⅰ及胰岛素 ,可促进蛋白质合成 ,改善营养状况 ,促进烧伤创面愈合。Objective To explore the effects of recombinant human growth hormone (rhGH) on postuburn hypermetabolism in burn patients and its mechanism. Methods Thirty-two patients inflicted with burn of 50% to 90% TBSA admitted to our department during past 5 years (1998-2002) were enrolled in the study and randomly divided into A (with 0.25 U·kg -1 ·d -1 of rhGH treatment on 7-10 PBD, n=16) and B (with 0.25 U·kg -1 ·d -1 of normal saline as control, n=16) groups. The changes in the rest energy expenditure (REE), non-protein respiratory quotient (NPRQ), glucose metabolism, nitrogen balance as well as plasma levels of endocrines and inflammatory mediators were determined before and after the administration of rhGH. Results rhGH was given to patients in group A during 7-10 PBD. The NPRQ in group A began to increase at the 7th PBD, raised to 0.80±0.09 in the 21th PBD. The plasma levels of PGE 2,TXB 2,TNF-αand IL-6 significantly decreased and insulin, rhGH and IGF-1 obviously increased when compared with those in group B. The accumulated nitrogen loss in group A was also much lower than that in group B. The plasma levels of adrenaline, cortisol, glucagon in group A were significantly higher than those in group B(P<0.05). Conclusion The postburn administration of rhGH timely could regulate postburn hypermetabolism in severely burned patients by increasing the plasma levels of GH, IGF-1 and insulin, which was beneficial to the improvement of nutrition state and to the promotion of protein synthesis and wound healing.

关 键 词：重组人生长激素 烧伤 高代谢反应 调节作用 静息能量消耗 

分 类 号：R644[医药卫生—外科学]