围手术期应用生长激素对肠外营养病人肠粘膜通透性、细胞免疫功能及预后的影响

目的观察围手术期应用重组人生长激素(rHGH)对肠外营养病人肠粘膜通透性、小肠粘膜形态、细胞免疫功能和预后的影响。方法前瞻性、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进入本研究。术前3天至术后第7天，研究组病人接受rHGH(0.3IU

The impact of pretreatmentwith recombinant human growth hormone on intestinal barrier function and cell immunefunction

Objective To evaluate the effects of rHGH on intestinalpermeability, intestinal morphology and cell immune function. Methods A placebo-controlled randomized double-blind trial was performed. 20 patients undergoing abdominal surgery were randomized into two groups. The patients in the study group received rHGH (0.3IU.kg-1.d-1) 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 isonitrogenic (N 0.15g.kg-1.d-1) and isocaloric (20 Kcal.kg-1.d-1) parenteral nutrition from the 1st preoperative day to the 6th postoperative day. The intestinal permeability, peripheral CD4+/CD8+ lymphocyte proportion, blood routine and biochemiscal analysis were determined before and after rHGH treatment. The jejunum biopsy was performed on the operation day for the determination of the intestinal morphology. Results 1) GH and IGF-1 levels were similar in the two groups and had not changed significantly in the control group by the 7th postoperative day. In the study group a significant increase in serum levels of GH and IGF-1 was observed on 3rd and 7th postoperative day. 2) The intestinal permeability (L/M) in the control group was elevated on POD+7 (P=0.01), whereas the L/M ratio in the study group kept the same as preoperative(P=0.08). No significant difference was observed on the jejunum morphology between the two groups. 3) A significant decrease in CD4+ subset proportion and CD4+/CD8+ ratio was observed in the control group on the 7th postoperative day, whereas no change was observed in study group. 4) No adverse reaction related with rHGH was observed. Glucose level in the control group was unaltered, but in the study group a trend of rising in glucose level was observed, which was not significant. 5) There was no significant difference in operation-related complication and period of hospital stay between the two groups. Conclusions 1) rHGH prevented the increase of intestinal permeability, preserved intestinal barrier function. 2) rHGH eliminated the depression in cellular immunity following the surgical stress.