重组人生长激素对严重烧伤患者体液分布及水钠潴留的影响

目的 了解重组人生长激素(rhGH)对严重烧伤患者体液分布及水钠潴留的影响.方法 成年重度烧伤患者30例,按区组随机法分为治疗组和对照组.伤后第7天开始分别为2组患者皮下注射rhGH(12 U/d)和等量等渗盐水,持续14 d.于伤后第7天(用药前)及伤后第14、21天(用药后第7、14天),应用生物电阻抗法观察2组患者机体总水量(TBW)、细胞内水量(ICW)及细胞外水量(ECW),同时应用离子选择电极法测量24 h尿钠,进行对比分析和综合统计. 结果 治疗组与对照组比较,伤后第7、14、21天的TBW、ICW、ECW及24 h尿钠变化差异无统计学意义(P＞0.05).各组内不同时相点比较,差异亦无统计学意义(P＞0.05).但将2组患者数据合并进行统一处理后.伤后第21天TBW值和ICW值分别为(36±6)、(21±4)L,与伤后第7天[(38±6)、(23±7)L]比较,差异有统计学意义(P＜0.01). 结论 重度烧伤患者随着病程延长,TBW和ICW逐渐减少,适量廊用rhGH对患者体液分布和水钠潴留无明显影响.     

重组生长激素对腹部大手术患者血浆蛋白的影响

目的研究重组人生长激素(rhGH)对腹部大手术患者术后代谢、免疫功能和术后并发症的影响。方法回顾性分析腹部大手术患者79人,其中37人为治疗组,42人为对照组。治疗组手术后第2天开始,每天皮下注射思真(重组人生长激素,瑞士雪兰诺公司生产)8U,对照组给予安慰剂(生理盐水),共用7d;分别在治疗前,治疗后3、7、10、14d检测血浆白蛋白、前白蛋白及转铁蛋白水平。记录切口愈合情况及术后并发症情况。结果(1)治疗前,两组白蛋白、前白蛋白及转铁蛋白水平差异无统计学意义(P>0.05);治疗后3d,两组白蛋白水平差异无统计学意义(P>0.05),且均低于治疗前;治疗组前白蛋白、转铁蛋白均高于对照组(P<0.05);治疗后7d,治疗组3项指标均高于对照组。(2)治疗组切口愈合情况明显优于对照组(P<0.05)。(3)治疗组术后并发症发生率明显低于对照组(P<0.05)。结论腹部大手术患者术后应用重组人生长激素可以提高免疫功能,促进切口愈合,减少术后并发症的发生。     

重组人生长激素在肝移植术后患者中的应用研究

目的 观察重组人生长激素（rhGH）在肝移植术后患者中的应用疗效.方法 将24例肝移植术后患者随机分为rhGH治疗组和对照组,每组12例.两组患者术前状态无明显差异,肝功能Child分级均为C级,术前无全身感染性疾病.rhGH治疗组在术后第3天起连续7 d皮下注射重组人生长激素（8 IU/d）,其他治疗同对照组.分别于术后第7、10、14天测定两组患者转氨酶、前白蛋白及免疫球蛋白水平.结果 治疗组ALT、AST水平在术后第7、10、14天均低于对照组,在第7和第10天的差异有显著意义（P＜0.05）;前白蛋白水平在术后第7、10、14天均高于对照组,并在第10、14天的差异有显著意义（P＜0.05）.治疗组在术后2周的白蛋白用量低于对照组,差异有统计学意义（P＜0.05）;而感染发生率低于对照组,在治疗期间两组均没有观察到急性排斥反应的发生.结论 rhGH能促进肝移植术后早期肝功能的恢复及白蛋白的合成,改善患者术后营养状态,降低感染发生率,短期使用不增加急性排斥反应的发生率.     

重组人生长激素影响重度烧伤患者预后的前瞻性多中心研究

目的观察重组人生长激素(rhGH)对重度烧伤患者预后的影响。方法采用前瞻性多中心随机对照临床试验,将207例成年重度烧伤患者随机分为治疗组(每日皮下注射rhGH)和对照组(同法注射等量等渗盐水),观察两组患者病死率、血糖变化和烧伤脓毒症发生情况。结果治疗组和对照组的病死率分别为0.89%、5.26%(P>0.05),高血糖发生率分别为36.61%、18.95%(以>10.00mmol/L为标准),差异有统计学意义(P<0.01),两组患者脓毒症发生率比较差异无统计学意义(P>0.05).结论适量rhGH在成年重度烧伤患者中应用是安全的,但需注意观察血糖的变化。     

严重烧伤患者应用重组人生长激素的时机--胰岛素样生长因子轴及血糖的变化分析

目的　分析重组人生长激素 (rhGH)对严重烧伤患者胰岛素样生长因子Ⅰ (IGF Ⅰ )、胰岛素样生长因子结合蛋白 3(IGFBP 3)及血糖的影响 ,寻找最佳用药时机。　方法　 4 0例严重烧伤患者随机分为对照组、伤后第 7～ 9天开始治疗组 (治疗组 1)和伤后第 10～ 14天开始治疗组 (治疗组2 )。观察伤后第 1、3、5、7、10、14、2 1天IGF Ⅰ、IGFBP 3、血糖动态变化并进行分析比较。结果　治疗组 1和治疗组 2应用rhGH后 ,上述 3项指标均有升高 ,其中IGFBP 3和血糖与对照组比较 ,差异有显著性意义 (P <0 .0 5 )。治疗组 1与治疗组 2比较 ,用药后各时相点的 3项指标差异无显著性意义 (P >0 .0 5 )。　结论　伤后第 7～ 9天是严重烧伤患者应用rhGH的较好时机。     

重组人生长激素应用于特发性弱精子症的临床疗效和安全性观察

目的:观察重组人生长激素治疗特发性弱精子症的临床疗效和安全性。方法:采用随机对照实验设计,按WHO的标准诊断为特发性弱精子症40例患者,随机均分为应用组和对照组。在常规治疗下,应用组加用重组人生长激素,每次4U,隔日晚上皮下注射,对照组不加用重组人生长激素;疗程3个月。治疗前后按WHO标准进行精液分析,同时监测性激素、甲状腺功能、肝肾功能、血脂、血糖等指标。最终应用组18例,对照组18例完成本观察。结果:精子存活率应用组提高了(28.60±32.89)%,对照组提高了(8.42±25.87)%,差异有显著性(P<0.01);(a+b)级精子,应用组提高了(18.56±21.19)%,对照组提高了(8.12±24.34)%,差异有显著性(P<0.05);精子密度、精子总量的改善应用组较对照组差异有显著性(P<0.05)。结论:重组人生长激素对特发性弱精子症有辅助治疗效果、安全性高、能提高精子密度和精子总数。     

基因重组人生长激素（r-hGH)对骨质疏松性骨折愈合影响的实验研究

目的　观察基因重组人生长激素 (r- h GH)对骨质疏松性骨折愈合的作用及影响 ,以期为骨质疏松性骨折提供一种有效的治疗方法。方法　选择 8月龄、雌性、SD大鼠 36只 ,随机分为治疗组与对照组 ,每组各 18只。手术方法建立骨质疏松性骨折实验模型后 ,治疗组动物每只每天皮下注射基因重组人生长激素 (r- h GH) 2 .7mg/ kg,连续 10天 ;对照组同法给予等量生理盐水。分别于用药后 2、4、8周检测血浆 IGF- 1浓度 ,并进行骨痂组织骨密度 (BMD)测定、骨痂组织力学强度测试等。结果　血浆 IGF- 浓度 :2周时 ,治疗组血浆 IGF- I浓度值较对照组明显增高 (P<0 .0 0 5) ,4～ 8周时 ,两组血浆 IGF- 浓度值水平相近 (P<0 .5或 P>0 .5) ;骨痂组织 BMD:4周时治疗组较对照组高 (P<0 .2 ) ,8周时却较对照组低 (P<0 .0 0 1) ;力学强度测试 :4～ 8周治疗组骨痂组织各扭转力学强度参数均较对照组高 ,其中最大扭转角在 4周时两组间差异显著 (P<0 .0 5)。结论　外源性基因重组人生长激素 (r- h GH)对实验性骨质疏松性骨折愈合有一定的促进作用。     

重组人生长激素对正畸牙移动和牙根吸收影响的动物实验研究

目的：研究重组人生长激素（Recombinant human growth hormone,rhGH）对大鼠牙根吸收模型正畸牙移动和牙根吸收的影响。方法：选择实验动物中心提供的健康Wistar雄性大鼠40只，使用单纯随机抽样法分为生长激素组和对照组，各20只。两组均于恒温环境下按照实验动物管理和使用指南对所有大鼠进行饲养和处理。为两组大鼠安装矫治器，并从安装矫治器当天起，生长激素组按照每天2 mg/kg的总剂量对大鼠注射生长激素，分两次注射（即单次1 mg/kg）；对照组按照相同剂量和频率对大鼠进注射生理盐水。对比不同时点两组大鼠牙移动距离、牙根吸收指数、胰岛素样生长因子I(InsulinlikegrowthfactorI,IGF-I)阳性破骨细胞数和阳性牙周膜细胞数。结果：与对照组相比，第7、14天生长激素组牙移动距离较远，差异有统计学意义（P<0.05）。与对照组相比，第5、7、14天生长激素组牙吸收指数较低，差异有统计学意义（P<0.05）。生长激素组阳性破骨细胞数第1天至第5天呈上升趋势，第5天至第14天呈下降趋势；对照组阳性破骨细胞数第1天至第7天呈上升趋势，第7...     

复方荆芥熏洗剂治疗急性肛裂100例临床观察

目的:观察复方荆芥熏洗剂坐浴治疗急性肛裂患者的疗效。方法:将急性肛裂患者100例随机分为观察组和对照组，每组50例。观察组患者采用复方荆芥熏洗剂坐浴治疗，对照组患者采用常规温水坐浴治疗，坐浴后第1、3、7天进行疼痛评分、便血评分，第7天进行临床疗效评价。结果:治疗前2组患者疼痛、便血评分比较差异无统计学意义(P>0.05),治疗后第1、3、7天观察组患者疼痛评分明显低于对照组(P<0.05),治疗后观察组患者第3、7天便血评分明显低于对照组(P<0.05),观察组患者治愈率和总有效率均高于对照组(P<0.05)。结论:采用复方荆芥熏洗剂治疗急性肛裂可有效减轻患者的疼痛，减少便血，临床效果显著。     

小剂量高渗氯化钠羟乙基淀粉40对自然杀伤细胞和血小板CD41的影响

目的 观察术中高渗氯化钠羟乙摹淀粉40注射液(HSS40)对恶性肿瘤患者体内自然杀伤细胞(NK细胞)和血小板活化分子CD41影响.方法 将76例手术患者随机分两组:输血组(A组)38例、HSS40组(B组)38例.于麻醉前1 h、术后1、3、7 d抽取外周血,细胞检测仪检测CD56和CD41含量;以乳酸脱氢酶释放法检测NK细胞活性.结果 组间比较:CD56术后第3、7天B组高于A组,差异显著(25.560±11.026比15.648±6.729;29.040±10.221比15.035±6.758,P<0.01),NK细胞活性术后第7天两组比较差异有统计学意义(19.939±6.994比15.307±5.107,P<0.05);CD4,术后l d B组明显低于A组(7.740 4-4.101比10.752 4-5.493,P<0.01).组内比较:A组术后第3天NK细胞活性下降(P<0.05),术后第7天下降明显,与术前比较差异有统计学意义(P<0.01),B组术后第7天NK细胞活性与术前比较差异有统计学意义(P<0.05),CD56术后第3天有所上升(P<0.05),术后第7天上升明显,与术前比较差异有统计学意义(P<0.01).两组CD41术后1～7 d均明显高于术前水平(P<0.01).结论 手术和输血可导致术后NK细胞活性降低,血小板CD41含量明显升高,术中输注HSS40,术后NK细胞活性及数目不同程度升高,且降低血小板CD41含量.     

重组人生长激素对大鼠肠道缺血再灌注后肠壁组织T淋巴细胞亚群和浆细胞凋亡的影响

目的探讨肠道屏障功能损害时应用重组人生长激素（rhGH）对肠道免疫屏障中肠黏膜及固有层内T淋巴细胞亚群和浆细胞凋亡的影响。方法将60只Wistar大鼠雌雄各半随机分为实验组和对照组，按实验天数又各分为3组，每组10只，以肠缺血再灌注模型造成肠道屏障功能损害的病理现象，实验组给予rhGH每日（1．33U／kg体重），采用免疫组织化学双染法观察回肠末端黏膜固有层内CD8^＋、CD4^＋、CD3^＋T淋巴细胞数及IgA浆细胞的凋亡数量变化。结果（1）对照组CD3^＋T淋巴细胞及IgA浆细胞的凋亡数量第6天明显高于第2、4天。差异有统计学意义（P〈0．01）。（2）实验组CD8^＋、CD4^＋T淋巴细胞的凋亡数量第6天明显低于第4天，差异有统计学意义（P〈0．01）。（3）实验组与对照组相比第2、4、6天IgA浆细胞的凋亡数量均明显减少。差异有统计学意义（P〈0．01）。实验组与对照组相比大鼠第2天CD8^＋、CD4^＋、CD3^＋T淋巴细胞的凋亡数量均减少，差异有统计学意义（P〈0．05，P〈0．01）。结论肠道屏障功能损害时应用重组人生长激素能够减少肠道免疫细胞的凋亡数量，对IgA浆细胞作用最明显。可能的作用时间在第6天。     

Effect of growth hormone therapy in burn patients on conservative treatment

Evaluation of growth hormone therapy in burns is limited and none is reported from developing countries where burns still carry high mortality. We analysed serial observations on the clinical and biochemical profiles in 13 patients with second and third degree burns who received recombinant human growth hormone (rhGH) (0.5 IU/kg body wt) for 2 weeks in addition to standard conservative treatment and in 9 patients who were managed with standard conservative treatment only. The two groups of patients had burns, comparable in extent and severity. Additional rhGH treatment resulted in improved wound healing (p<0.001), delayed separation of eschars (p<0.01), increase in haemoglobin (p<0.05), serum albumin (p<0.01), calcium (p<0.05), phosphorus (p<0.001), glomerular filtration rate (p<0.05) and 7 fold elevation in IGF-1. Also, a reduction in weight loss (p<0.01), nitrogen production rate (p<0.05), catabolic index (p<0.01), duration of sepsis (p<0.01) and hospital stay by 40% (p<0.01) was noted with rhGH therapy. Transient hypercalcemia (3 patients), albuminuria (2 patients) and elevated blood glucose (one patient) were noted in the rhGH treated group not necessitating any specific therapy. Mortality in rhGH treatment group was 8.3% compared to 44.5% in the “no rhGH” treatment group. These observations suggest significant benefits of short term rhGH treatment in burn patients on conservative management.     

Effects of recombinant human growth hormone (r-hGH) on experimental osteoporotic fracture healing

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生长激素治疗对烧烫伤小儿生长发育的影响

目的：评价短期应用重组人生长激素（rhGH）对小儿烧烫伤的治疗效果及治疗后对其生长发育的影响。方法：选取82例住院烧烫伤患儿,随机分为rhGH治疗组58例和对照组24例。rhGH治疗组在常规治疗的基础上给予rhGH皮下注射0．3IU／kg,每晚1次,连续使用10d。对照组只给予常规治疗,于相应时间皮下注射2m1生理盐水。另选30例发育正常的整形患儿作为正常对照。动态观察应用rhGH（或生理盐水）前1d、应用后5d后,出院时及出院后6、12、18、24个月两组患儿血生长激素、血糖水平;患儿于入院时测量身高、体重,计算体质指数（BMI）,出院后6～24个月进行追踪性观察,与同时期同年龄段北京市正常小儿生长指标进行对比,评价影响。结果：rhGH治疗组创面愈合速度较对照组明显加快;创面愈合后瘢痕增生及痛痒程度明显轻于对照组,差异有显著性（P〈O．05）。rhGH治疗前两组血生长激素水平均明显低于正常水平。rhGH治疗第5天患儿的生长激素水平明显高于正常组水平和对照组（P〈0．001）,至出院时两组均趋于正常。伤后两组血糖水平均有轻度升高,激素治疗第5天恢复正常,但差异无显著性,两组之间各时间比较差异均无显著性。两组出院时体重和BMI均低于北京市儿童正常标准,但两组间身高、体重和BMI差异均无显著性。结论：临床短期小剂量使用生长激素治疗小儿烧烫伤能够加速创面愈合,提高创面愈合质量。创面愈合后小剂量短期应用的生长激素不会对小儿的生长发育造成后续影响。     

Somatic and renal effects of growth hormone in rats with chronic renal failure

Recombinant human growth hormone (rhGH) has been widely used to improve growth in children with chronic renal failure (CRF). However, there has been great concern that GH may aggravate renal disease and hasten the progression to end-stage renal failure. We therefore investigated the effect of prolonged administration of rhGH at various doses on somatic growth and renal function and structure in rats with CRF, divided into four groups based on rhGH dose (vehicle, 0.4, 2.0, and 10.0 IU/day). rhGH was administered subcutaneously daily for 8 weeks. The mean growth was significantly greater in rats treated with high-dose rhGH (10.0 IU) than those treated with low-dose rhGH (P = 0.0089) or vehicle (P = 0.0011). Body weight gain increased in parallel with body length (Creatinine clearance at the end of the experiment was significantly lower in rats on high or medium-dose rhGH than those on low-dose rhGH and controls (P <0.05). The glomerular sclerosing index was greater in rats treated with higher doses of rhGH. There were significant differences between rats treated with high-dose rhGH and controls (P = 0.0144) and also between rats on medium-dose rhGH and controls (P = 0.0065). Although there was no significant difference, rats treated with higher doses of rhGH tended to excrete more protein. Renal insulin-like growth factor-I (IGF-I) content and circulating IGF-I and IGF-II levels did not significantly differ among groups. We conclude that: (1) GH improves somatic growth failure in rats with CRF, but prolonged administration of GH dose-dependently induces deterioration in renal function and structure and (2) this effect was induced neither via circulating IGF-I and IGF-II nor by local production of IGF-I, but seems to be direct. Received June 7, 1996; received in revised form and accepted November 19, 1996     

重组人生长激素在体外对人胃癌细胞株BGC823作用的研究

目的　研究重组人生长激素 (rhGH)对人胃癌细胞生长的影响。方法　利用体外细胞培养测定不同浓度的rhGH对人胃癌细胞株BGC82 3的生长曲线、细胞抑制率和细胞倍增时间的影响。结果　rhGH在体外无明显促进BGC82 3细胞分裂增殖 ,rhGH组与对照组、rhGH +L OHP组与L OHP组比较差异均无显著意义 (P >0 0 5 ) ,且生长曲线没有升高 ;rhGH +L OHP组与对照组比较细胞抑制率为 6 3 2 %和 5 0 8% (P <0 0 1) ,细胞倍增时间为 82 5h和 39 6h(P <0 0 1) ;或rhGH+L OHP组与对应的rhGH组配对比较 ,细胞抑制率为 6 3 2 %和 1 7% (P <0 0 1) ,细胞倍增时间为82 5h和 37 2h(P <0 0 1)。结论　rhGH在体外无明显促进胃癌细胞的分裂增殖 ,与抗肿瘤药合用可提高抗肿瘤药的疗效。     

Growth hormone treatment in pediatric burns: a safe therapeutic approach.

OBJECTIVE: To determine the safety and efficacy of recombinant human growth hormone (rhGH) in the treatment of children who are severely burned. SUMMARY BACKGROUND DATA: During the last decade, we have used recombinant human growth hormone (rhGH; 0.2 mg/kg/day s.q.) to successfully treat 130 children with more than 40% total body surface area (TBSA) burns to enhance wound healing and decrease protein loss. A significant increase in the mortality of adult patients in the intensive care unit who were given rhGH has recently been reported in two large European trials which questions the therapeutic safety of rhGH. METHODS: The records of 263 children who were burned were reviewed. Patients receiving either rhGH at 0.2 mg/kg/day subcutaneously as part of a randomized clinical trial (n = 48) or therapeutically (n = 82) were compared with randomized placebo-administered controls (n = 54), contiguous matched controls (n = 48), and matched patients admitted after August 1997, after which no patients were treated with rhGH (n = 31). Morbidity and mortality, which might be altered by rhGH therapy, were considered with specific attention to organ function or failure, infection, hemodynamics, and calcium, phosphorous, and albumin balance. RESULTS: A 2% mortality was observed in both rhGH and saline placebo groups in the controlled studies, with no differences in septic complications, organ dysfunction, or heart rate pressure product identified. In addition, no difference in mortality could be shown for those given rhGH therapeutically versus their controls. No patient deaths were attributed to rhGH in autopsies reviewed by observers blinded to treatment. Hyperglycemic episodes and exogenous insulin requirements were higher among rhGH recipients, whereas exogenous albumin requirements and the development of hypocalcemia was reduced. CONCLUSIONS: Data indicate that rhGH used in the treatment of children who were severely burned is safe and efficacious.     

生长激素对肝大部切除术后鼠肠黏膜的保护作用

目的: 探讨鼠肝大部切除术后生长激素对肠黏膜屏障的保护作用,为临床使用重组人生长激素保护肠黏膜提供实验依据.方法: 90只SD大鼠随机分为对照组、生理盐水(normal saline,NS)组和生长激素(recombinant human growth hormone,rhGH)组,后两组切除肝左叶和右叶;各组连续用药6 d,分别于术后第1,2,3,5和10天取回肠组织行光镜形态学观察及图像分析检测肠黏膜厚度和绒毛高度,并对回肠黏膜上皮细胞行核增殖抗原(proliferate cell nucleus antigen,PCNA)免疫组织化学测定;取心脏血4~6 ml,检测内毒素.结果: 肝大部分切除术后第1,2天,内毒素明显升高,而rhGH组与对照组无明显差异.术后第3,5天,回肠黏膜明显萎缩,绒毛变薄;黏膜上皮细胞PCNA明显下降(P<0.01).应用rhGH 3 d后,回肠绒毛高度、黏膜厚度和PCNA度均增加(P<0.01);术后第5天,达到对照组水平.结论: 肝大部分切除术后肠黏膜屏障受损,应用rhGH可保护肠黏膜屏障,减少血浆内毒素水平.     

Increased survival rate in patients with massive burns.

A review of 113 patients with massive burns treated in our centre from 1970 to 1989 is presented. There were 57 adults patients with massive burns (> or = 50 per cent TBSA) in 1980-89 who were compared with 56 patients with similar massive burns in the period between 1970 and 1979. The results show a significant improvement (P < 0.01) in survival rate of the more recent patients. The increased survival rate is attributed to improvements in the early treatment of inhalation injury, sepsis and multiorgan failure.