手术前开始应用生长激素对肠外营养病人蛋白质代谢、肌肉功能、肠粘膜屏障和细胞免疫功能的影响  

The impact of preoperative treatment of recombinant human growth hormone on protein metabolism, muscle function, intestinal barrier function and cell immune function

作　　者：刘卫[1] 蒋朱明[1] 于健春[1] 王秀荣[1] 舒红[1] 崔巍[1] 李德敏[1] 

机构地区：[1]北京协和医院外科

出　　处：《中国临床营养杂志》2000年第1期34-35,共2页Chinese Journal of Clinical Nutrition

摘　　要：生长激素（GH）在术后应用已有报告，其代谢效应在术后3～4天出现，为探索创伤后分解代谢的进一步改善，术前开始应用重组人生长激素（rHGH）。目前国内外均无术前应用rHGH的报告。目的（1）观察手术前3天开始应用rHGH治疗能否使以往研究中于术后第4天出现的正氮平衡在术后提早出现，并观察其对术后肌肉功能的影响。（2）观察手术前后应用rHGH对肠外营养病人肠粘膜通透性、小肠粘膜形态及细胞免疫功能的影响。方法本研究为前瞻性、随机、双盲、安慰剂对照的临床研究。20例因胃肠道疾病行手术治疗的病人随机进入研究组或对照组。术前3天至术后第7天，研究组病人接受rHGH（0.3IU·kg－1·d-咐，皮下注射）治疗，对照组接受安慰剂。从术前1天至术后第6天，两组病人接受等氮等热卡的肠外营养（20Kcal·kg－1·d-1,0．15gN·kg-1·d-1。观察指标包括：术后6天的氮平衡，手术前后体重、双手握力、行走速度、血浆谷氨酰胺水平、肠粘膜通透性、外周血淋巴细胞亚群、血常规和肝、肾功能变化及小肠粘膜形态。结果1．研究组术后6天累积氮平衡明显好于对照组（P＜0.01），并于术后第2天开始出现持续的正氮平衡，而对照组术后6天持续为负氮平衡。2.对照组病人术后体重、双手握力和行走速度均较术前下降（P＜0.05），?<Absatract>objective 1. To determine if the positive nitrogen balance could be achieved in early petoperative pered by the pretreatment of rHGH. 2. To evaluate the effects of rHGH on intestinal permeability,intestinal morPhofogy and cell immune function. Metbds A placebocontro1led randomized double-blind trial were performed. 20 patients undergoing abdominal sumery were randomed into two groups. The patients in the study group received rHGH (0. 3IU/kg/day) subcutaneously from the 3rd day before operation onward to the 7th day after operation. The patients in the control group received placebo. All the patients were given iamitrogenic (0. 15g N/kg/ day) and isocaloric (20Kcal/kg/day) parenteral nutrition from the 1st preoperative day to the 6th postoperative day. The Nitrogen balance and cumulative nitrogen balance were calculated during the 6 postoperative days. The body weight, hands grip strength, and the time requested to walk 20 meters were evaluated, the plasma glutamine level, peripheral CD /CD lyrnphocyte proportion, blood routine and biochemistry analysis, intestinal permeability were determined before and after rHGH treatment. A jejunum biopsy was performed on the operation day for the determination of the intestinal morphology. Results 1 ) The positive nitrogen balance was achieved from the 2nd postoperative day onward with the pretreatment of rHGH,whereas the negative nitrogen balance lasted during the optoperative 6 days in the control group. The cumulative nitrogen balance in the study group was significantly better than that in the contro group (P < 0. 01 ). 2) In the control group,they weigh, hands grip strength decreased,and the time requested to walk 20 meters increased significantly compared to the preoperative level (P < 0. 05 ). In the study group, there were no significant changes on the 7the petoperative day (P > 0. 05 ). The changes between the two groups were significantly different(P < 0. 05). 3) GH and IGF I levels were similar in the two groups and had not significantly changed in the

关 键 词：细胞免疫功能 蛋白质代谢 肠粘膜屏障 肠外营养 肌肉功能 手术前 生长激素(GH) 重组人生长激素 病人 术后应用 代谢效应 分解代谢 rHGH 术前应用 创伤后 国内外 

分 类 号：R459.3[医药卫生—治疗学]