生长抑素和生长激素联合应用治疗重症急性胰腺炎的临床研究

目的 探讨生长抑素和生长激素联合应用治疗重症急性胰腺炎（ＳＡＰ）的疗法。方法 对３２例ＳＡＰ，随机分为生长抑素治疗组（ｎ＝１１），生长激素和生长抑素联合应用治疗组（ｎ＝１０）以及对照组（ｎ＝１１）。观察各组治疗后血清ＩＬ－１，ＩＬ－６和ＴＮＦα的变化，住院日数，并发症和死亡率。结果 生长 抑素和生长激素联合组能冯少并发症，降低死亡率，缩短住院日数，抑制ＳＡＰ病人的炎性细胞因子高表达，促进白蛋白合成     

胰性脑病临床治疗的探讨

目的：探讨胰性脑病（PE）临床治疗方法,降低重症急性胰腺炎（SAP）的病死率。方法：SAP伴发的早期可疑PE7例,采用重组人生长激素（ rhGH）治疗,4U／次,每日2次,5－7天。联合用药组以生长抑素合用rhGH治疗SAP,共13例,剂量及时间同早期PE组。结果：应用后rhGH24h,病人精神障碍改善,48－72h后症状消失,本组7例全部治愈。联合用药治疗SAP13例,未见PE的发生。结论：生长激素对早期PE有治疗作用,生长激素与生长抑素联合应用有可能降低PE的发生。     

生长抑素治疗急性重症胰腺炎临床对比观察

作者对生长抑素治疗急性重症胰腺炎、抑制胰液分泌的作用进行了临床对比观察。１９９２年２月至１９９５年１１月，作者共收治急性重症胰腺炎２１例，按时间先后分为对照组（ｎ＝１２）及生长抑素治疗组（ｎ＝９）。对照组采用常规治疗，治疗组除常规疗法外，于发病２４小时内开始应用生长抑素持续静脉点滴，６ｍｇ／ｄ，连续５～７天。两组患者入院时一般情况比较差异无显著性。治疗组于第２、３、４天胃肠减压量显著低于对照组（Ｐ＜０．０５），血淀粉酶也较对照组下降迅速。治疗组发生各种并发症１２人次，对照组１７人次（Ｐ＞０．０５）。治疗组临床治愈时间１５．６±４．８天，对照组为２１．５±７．６天（Ｐ＝０．０２）。作者认为生长抑素是一种较好的胰液及胰酶分泌抑制剂，在急性重症胰腺炎发病初期开始应用，能在一定程度上控制病情发展，缩短临床治愈时间。     

生长抑素治疗急性重症胰腺炎临床观察

目的探讨生长抑素十四肽(施他宁)治疗急性重症胰腺炎的疗效。方法总结1996年至2006年收治的急性重症胰腺炎病例,将保守治疗的病例分为生长抑素十四肽治疗组(治疗组)和非生长抑素十四肽组(对照组),比较两组的疗效,治疗组采取常规治疗加用施他宁持续静脉滴注3～5d,对照组采取常规治疗。结果治疗组临床症状和体征恢复好转时间比对照组提前3～6d,并发症减少,降低病死率,住院天数减少。结论施他宁能在一定程度上控制病情发展,减少并发症发生,降低病死率,对于重症胰腺炎治疗有重要价值,早期应用生长抑素十四肽可以明显改善重症急性胰腺炎的治疗效果。     

蛇毒抗栓酶生长抑素对大鼠胰腺炎微循环的影响

急性坏死性胰腺炎（ＡＮＰ）是临床较棘手的常见病,其病死率高达３０％～８０％。研究证明,胰腺缺血与胰酶自身消化均为急性胰腺炎（ＡＰ）的重要因素。本文以蛇毒抗栓酶与生长抑素联合来研究其治疗ＡＰ的作用。材料与方法回动物与分组ＳＤ大鼠４０只,随机分为４组：Ａ对照组（ｎ—１０）;Ｂ急性胰腺炎模型组（ｎ—１０）;Ｃ蛇毒抗栓酶３号十生长抑素十四肽（Ｓ＋ＳＩ）处理组（ｎ一１０）;蛇毒抗栓酶３号十生长抑素八肽（Ｓ＋Ｘｉ）处理组（ｎ—１０）。２动物模型制备采用十二指肠主胰管开口处逆行注人５％牛黄胆酸钠和２％胰蛋白酶…     

生长抑素联合中药胃管注入治疗重症急性胰腺炎的临床效果

目的探讨生长抑素联合加味大黄承气汤胃管注入治疗重症急性胰腺炎的效果。方法按入院顺序将226例重症急性胰腺炎患者分为2组,各113例。对照组给予生长抑素治疗,观察组运用生长抑素联合加味承气汤胃管注入,对比2组疗效、并发症发生率、中转手术率、病死率及住院时间等指标。结果观察组的有效率(96.46%)明显高于对照组(84.07%),差异有统计学意义(P0.05);2组患者血清AMY与CRP与治疗前相比较均下降,Ca2+均升高,观察组各项数据变化的幅度明显大于对照组,差异有统计学意义(P0.05);观察组患者治疗后症状恢复的时间及住院天数均少于对照组,差异有统计学意义(P0.05);观察组的中转手术率、病死率及并发症发生率均明显低于对照组,差异有统计学意义(P0.05)。结论生长抑素联合加味大黄承气汤胃管注入,可明显提高急性胰腺炎治愈率,缩短患者恢复及住院时间,降低手术率、病死率及并发症的发生率。     

善宁和生长激素联合应用治疗重症急性胰腺炎的临床研究

目的　探讨联合应用善宁和生长激素治疗重症急性胰腺炎 (SAP )的疗效。方法　对 60例SAP ,随机分为善宁治疗组 (n =15 ) ,生长激素和善宁联合治疗组 (n =3 0 )以及对照组 (n =15 )。观察并对比各组治疗后血清IL 1,IL 6,TNF α和清蛋白的变化、住院天数、并发症发生率和病死率。结果　联合治疗组的中转手术率、并发症发生率、病死率、住院天数均明显低于善宁组及对照组 (均 P <0 .0 5 ) ;联合组抑制SAP的炎性细胞因子高表达及促进清蛋白合成的作用亦优于善宁组及对照组 (均P <0 .0 5 )。结论　善宁和生长激素联合应用是治疗SAP的有效方法 ;其对改善损伤器官功能及预防多器官功能障碍综合征的发生有肯定作用。     

CRRT治疗老年重症急性胰腺炎患者的疗效观察

目的探讨连续性肾脏替代治疗（CRRT）在老年重症急性胰腺炎（SAP）患者中的疗效。方法收集老年重症急性胰腺炎患者34例,其中治疗组20例在常规综合治疗基础上行CRRT治疗;对照组14例行常规综合治疗。通过比较两组病人平均体温、白细胞计数、C反应蛋白、降钙素原转为正常的天数以及平均住院天数、并发症发生率及死亡率,评估CRRT治疗老年重症急性胰腺炎患者的疗效。结果治疗组平均体温、白细胞计数、C反应蛋白、降钙素原转为正常的天数以及平均住院天数均明显短于对照组,两组比较差异有显著性（P〈0．05）。并发症发生率及死亡率与对照组无明显差异（P〉0．05）。结论CRRT治疗老年SAP患者可有效提高治疗效果,缩短住院时间,并且不会增加并发症发生率及死亡率。     

早期经鼻肠内营养在急性重症胰腺炎中的应用

目的 探讨早期经鼻肠内营养（EN）在急性重症胰腺炎（ASP）中应用的安全性和有效性。方法 以近2年来的ASP26例分：EN组12例,TPN组14例。其治疗结果作对比,观察住院天数、各种并发症、病死率和费用的差异。结果 EN组平均住院天数,ARDS和其他感染性并发症均低于TPN组,病死率明显下降,治疗总费用显著减少。结论 EN在ASP中的应用是安全有效的,值得提倡。     

白细胞介素10与犬急性胰腺炎

目的 探讨白细胞介素１０（ＩＬ－１０）在犬急性胰腺炎（ＡＰ）中的作用，方法 用ＥＬＩＳＡ法检测了１１只急性水肿性胰腺炎（ＡＥＰ）犬和１２只急性出血坏死性胰腺炎（ＡＨＮＰ）犬发病前后血清ＩＬ－１０的活性，并与７只正常对照犬进行比较。结果 ＡＥＰ犬发病后２４小时内血清ＩＬ－１０活性明显高于ＡＨＮＰ犬（Ｐ〈０．０１），但至４８小时时，两组间ＩＬ－１０活性已无明显差异；而对照组犬及实验组犬ＡＰ发病前血清中     

低氮低热卡肠外营养联合激素治疗在胃肠道肿瘤患者术后的应用

目的 探讨临床低氮低热卡肠外营养(HPN)结合激素替代疗法治疗胃肠肿瘤患者的安全性和有效性.方法 将100例经过手术治疗的,营养风险评分3或4的胃肠肿瘤患者随即分成2组.对照组给予标准的全肠外营养(TPN)和胰岛素.实验组除给予HPN、胰岛素外,还联合给予重组人生长激素(r-hGH)和奥曲肽.观察两组间激素水平、蛋白质代谢、免疫功能、临床疗效及不良反应的不同,对临床的效果和安全性进行评估,并随访调查预后.结果 相对于对照组,HPN联合r-hGH,奥曲肽以及胰岛素治疗的实验组显著增强了患者蛋白质的合成,免疫功能和代谢性耐受,减少了感染和并发症的发生,缩短了住院时间,但未增加肿瘤复发和演进的风险.结论 围手术期短期联合应用生长激素、生长抑素,胰岛素和HPN,能通过增加蛋白质的合成,提高免疫功能来减轻胃肠癌症患者术后应激反应.     

低氮低热卡肠外营养联合激素治疗在胃肠道肿瘤患者术后的应用

目的 探讨临床低氮低热卡肠外营养(HPN)结合激素替代疗法治疗胃肠肿瘤患者的安全性和有效性.方法 将100例经过手术治疗的,营养风险评分3或4的胃肠肿瘤患者随即分成2组.对照组给予标准的全肠外营养(TPN)和胰岛素.实验组除给予HPN、胰岛素外,还联合给予重组人生长激素(r-hGH)和奥曲肽.观察两组间激素水平、蛋白质代谢、免疫功能、临床疗效及不良反应的不同,对临床的效果和安全性进行评估,并随访调查预后.结果 相对于对照组,HPN联合r-hGH,奥曲肽以及胰岛素治疗的实验组显著增强了患者蛋白质的合成,免疫功能和代谢性耐受,减少了感染和并发症的发生,缩短了住院时间,但未增加肿瘤复发和演进的风险.结论 围手术期短期联合应用生长激素、生长抑素,胰岛素和HPN,能通过增加蛋白质的合成,提高免疫功能来减轻胃肠癌症患者术后应激反应.

Abstract：

Objective The metabolic response to gastrointestinal cancer in patients undergoing surgery is associated with hypermetabolism and insulin resistance. The potential use of synergetic anabolic hormones in conjunction with hypocaloric parenteral nutrition ( HPN) has become a significant area of investigation. The current study was performed to determine the clinical efficiency and safety of combined hormone therapy in addition to HPN in gastrointestinal cancer patients. Methods One hundred patients with the nutrition risk screening ( NRS) score of 3 or 4 undergoing surgery for gastrointestinal cancer were randomized into two groups. The patients in the control group received standard total parenteral nutrition (TPN) and systemic insulin. The patients in the study group received HPN and systemic insulin in addition to the pretreatment of recombinant human growth hormone ( r-hGH) and octreotide. Clinical efficiency and safety were evaluated by the measurement of hormones and protein metabolites, immune function, clinical outcome,and adverse events. Follow-ups were performed to determine the influence on prognosis. Results Treatment with r-hGH, octreotide, and insulin in combination with HPN significantly increased protein synthesis , immune function and metabolic tolerance, decreased infectious complications, and shortened postoperative hospital stays, but did not increase the risk of tumor development and recurrence in the study group compared to the control group. Conclusion The proper short-term perioperative administration of growth hormone,somatostatin,and insulin in combination with HPN can overcome the postoperative stress response through the increase of protein synthesis to improve immune function in gastrointestinal cancer patients after surgery.     

低氮低热卡肠外营养联合激素治疗在胃肠道肿瘤患者术后的应用

目的 探讨临床低氮低热卡肠外营养(HPN)结合激素替代疗法治疗胃肠肿瘤患者的安全性和有效性.方法 将100例经过手术治疗的,营养风险评分3或4的胃肠肿瘤患者随即分成2组.对照组给予标准的全肠外营养(TPN)和胰岛素.实验组除给予HPN、胰岛素外,还联合给予重组人生长激素(r-hGH)和奥曲肽.观察两组间激素水平、蛋白质代谢、免疫功能、临床疗效及不良反应的不同,对临床的效果和安全性进行评估,并随访调查预后.结果 相对于对照组,HPN联合r-hGH,奥曲肽以及胰岛素治疗的实验组显著增强了患者蛋白质的合成,免疫功能和代谢性耐受,减少了感染和并发症的发生,缩短了住院时间,但未增加肿瘤复发和演进的风险.结论 围手术期短期联合应用生长激素、生长抑素,胰岛素和HPN,能通过增加蛋白质的合成,提高免疫功能来减轻胃肠癌症患者术后应激反应.     

Histologic changes in the rat prostate cancer model after treatment with somatostatin analogs and D-Trp-6-LH-RH

Histopathologic changes produced during the treatment of Dunning R3327 prostate cancer with new superactive somatostatin analogs (RC-121 and RC-160) and D-Trp-6 analog of luteinizing hormone-releasing hormone agonist (D-Trp-6-LH-RH) were studied. A significant reduction of the tumor weight could be observed in all treated groups, but the greatest decrease in the tumor volume was seen in the groups receiving the combination of the somatostatin analog and D-Trp-6-LH-RH. Histologically, the treatments resulted in a loss of the tumorous glandular elements and the proliferation of the stromal cells. In the tumors treated with somatostatin analogs, the amount of connective tissue was greatly increased and was accompanied by the appearance of thick collagenous fibers. In the D-Trp-6-LH-RH treated groups, regressive changes in the epithelium were seen in addition to the proliferation of connective tissue. The greatest histologic improvement was observed in the group treated with the combination of RC-160 and D-Trp-6-LH-RH. This histopathologic evaluation clearly supports our contention that superactive analogs of somatostatin greatly potentiate the inhibitory effect of D-Trp-6-LH-RH on the growth of Dunning prostate tumors and may improve the clinical response in patients with prostate cancer.     

Treatment of adenocarcinoma of the pancreas with somatostatin and gonadoliberin (luteinizing hormone-releasing hormone). The French Associations for Surgical Research.

Experimental studies have shown a significant inhibition of adenocarcinoma of the pancreas by gonadoliberin (luteinizing hormone-releasing hormone [LH-RH]) and somatostatin. The aim of this prospective randomized study was to compare the potential value of somatostatin (250 micrograms every 8 hours), LH-RH (3.75 mg monthly), or combined, to a control group. One hundred sixty-three patients with adenocarcinoma of the pancreas who did not undergo resection for cure were divided into 4 groups that did not differ in terms of clinical, biologic, or pathologic data. The mean survival times were 6 months in the LH-RH plus somatostatin group, 5.5 months in the LH-RH group, 4.3 months in the control group, and 3.8 months in the somatostatin group. However, the life-table analyses for all randomized patients, and separately according to sex, the lymph node extension, and metastatic spread were not different between groups. Improvement of patient status was observed in 20% of the patients receiving hormone therapy without any difference noted between the treatment regimens. These disappointing results may be explained by the degree of extension of pancreatic carcinoma in the patients studied. The results suggest that different hormone therapy regimens might be considered according to the age and the sex of patients, as well as to the presence or absence of hormone receptors.     

Comparison between somatostatin analogues and ACE inhibitor in the NOD mouse model of diabetic kidney disease.

BACKGROUND: The growth hormone (GH)-insulin-like growth factor (IGF)-SST (SST) axis is involved in diabetic nephropathy (DN). We have recently shown a beneficial effect on diabetic kidney disease markers by the use of a novel somatostatin (SST) analogue (PTR-3173) (S). The purpose of this study is to compare the effects of S with a previously used SST analogue (octreotide) and an ACE inhibitor (ACEi), a standard of care in DN. METHODS: Non-obese diabetic mice (a model of type I diabetes) were treated with either S (DS), octreotide (DO), enalapril (DA), or PTR-3173 and enalapril (DAS group) for 3 weeks. RESULTS: Diabetic renal hypertrophy was blunted in the DS and DO groups only. Serum GH and IGF-I were markedly increased and decreased, respectively, in the D group, a change significantly blunted in DO and DS. Diabetic hyperfitration and albuminuria were blunted in all the four treated diabetic groups. The marked deposition of type IV collagen and PAS material were mildly decreased in DA, but more markedly reduced in DS as well as DO. Diabetic renal laminin accumulation was suppressed in all treated animal groups. No synergistic effect was observed for any parameter in the combination group DAS. CONCLUSION: SST analogues exert beneficial effects in most parameters of diabetic kidney disease to the same extent as the ACEi. Enalapril treatment had no effect on renal hypertrophy and did not cause a significant decrease in mesangial type IV collagen deposition. A synergistic effect of combined SST-ACEi therapy could not be shown in this study.     

Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates

OBJECT: The question of whether preoperative therapy with somatostatin analogs can improve surgical outcome in acromegaly has not been definitively answered. In this paper, the authors report the effects of preoperative treatment with somatostatin analogs in a large sample of patients with acromegaly. METHODS: Between 1990 and 2003, 399 consecutive patients with acromegaly underwent surgery at the Istituto Scientifico San Raffaele. Thirty-three patients who had previously undergone surgery or radiation treatment, 48 patients treated with somatostatin analogs for fewer than 3 months, and patients who had stopped therapy for too long a time before surgery were excluded from the study. One hundred forty-three patients who had received somatostatin analogs prior to surgery (Group 1) were randomly matched to 143 patients who had never been treated with somatostatin analogs (Group 2). Matching criteria were tumor size and invasiveness into the cavernous sinus. Before surgery, Group 1 patients showed reduction of growth hormone levels to less than 50% of baseline in 64% of cases, but insulin-like growth factor-I was normalized in only 19.5%. Surgical remission occurred in 81 Group 1 patients (56.6%) and in 91 Group 2 patients (63.6%; p = 0.28). No significant difference in the remission rate was observed when cases were analyzed according to tumor size or invasiveness. Logistic regression analysis confirmed that pretreatment with somatostatin analogs was not associated with surgical outcome. Surgical morbidity was mild and similar in Group 1 and Group 2 patients (7 and 5.6%, respectively; p = 0.81). Surgical remission and complication rates in patients with acromegaly who received treatment with somatostatin analogs prior to surgery were not significantly different from those of matched patients who did not receive these agents. CONCLUSIONS: At present, the routine use of presurgical therapy with somatostatin analogs for patients with acromegaly cannot be recommended.     

生长抑素抑制人结肠癌细胞增殖的实验研究

目的：研究外源性生长激素（GH）和生长抑素（SS）对人结肠癌细胞株HT-29的影响，并探讨其作用机制。方法：人结肠癌细胞株HT-29分成正常对照组、生长抑素组（SS组）、生长激素组（GH组）和生长抑素＋生长激素组（GH＋SS组）。MTT法测定细胞抑制率，流式细胞仪测定细胞周期分布、增殖指数、凋亡率，RT—PCR方法测定bcl．2及baxmRNA水平。结果：生长抑素能够明显抑制人结肠癌细胞株HT-29增殖（P〈0．01）、降低S期和G2／M期细胞比例（P〈0．05）、降低增殖指数（PI）（P〈0．05）、促进细胞凋亡（P〈0．01）、降低bcl-2mRNA表达（P〈0．05）、提高baxmRNA表达（P〈0．01），生长激素则无明显作用。GH＋SS组表现与SS组相似。结论：生长抑素可能通过抑制GdG．期细胞进入S期和G2／M期以及促进细胞凋亡两种途径抑制体外培养的人结肠癌细胞株HT-29增殖。生长抑素可能是通过改变bax基因和bcl-2基因的表达影响肿瘤细胞的凋亡。生长激素对体外培养的人结肠癌细胞株HT-29无显著影响。     

质子泵抑制剂联合生长抑素治疗肠梗阻的效果分析

目的：探讨质子泵抑制剂联合生长抑素治疗单纯性肠梗阻的临床治疗效果。方法选择我院收治的258例单纯性肠梗阻患者随机分为观察组和对照组各129例,所有患者均给予基础治疗,观察组在此基础上采用质子泵抑制剂联合生长抑素治疗,对照组仅给予生长抑素治疗,治疗后对比两组患者疗效情况。结果观察组总有效率91.47%,明显高于对照组的61.24%,两组比较差异具有统计学意义（P＜0.05）;观察组腹胀缓解时间、腹痛缓解时间、肛门排气时间和住院时间均明显低于对照组,两组比较差异具有统计学意义（P＜0.05）。结论质子泵抑制剂联合生长抑素治疗单纯性肠梗阻疗效好、恢复快、无明显不良反应,值得临床推广应用。     

Radiographic evaluation of the upper cervical spine in rheumatoid arthritis: a retrospective analysis

We analysed retrospectively 295 lateral roentgenograms of the cervical spine in 150 patients with classic or definite rheumatoid arthritis. In addition to measuring the atlantodental interval, measurements of the different vertical parameters described by McGregor, Ranawat and Redlund-Johnell and a new measurement method with high reproducibility were described and their results compared statistically. As a control group we analysed 100 lateral roentgenograms of the cervical spine in patients with no inflammatory disease, posttraumatic lesion, tumour or osseous deformity.