重组人生长激素在COPD合并呼吸衰竭患者机械通气中的应用

目的探讨慢性阻塞性肺疾病（COPD）合并呼吸衰竭患者行机械通气时应用重组人生长激素（rhGH）的治疗效果。方法42例COPD合并呼吸衰竭行机械通气治疗患者随机分为对照组（22例）、rhGH组（20例）,对照组按常规给予营养支持,rhGH组除营养支持外,从上机第1日始每日皮下注射rhGH8IU,连用2周,观察两组患者治疗前后血清总蛋白、白蛋白、C反应蛋白、血糖和呼吸功能的变化,观察机械通气时间、住ICU时间和呼吸机相关性肺炎（VAP）发生率。结果rhGH组治疗后血清总蛋白、白蛋白水平明显高于对照组,C反应蛋白水平明显低于对照组（P均〈0.05）;rhGH组机械通气时间、住ICU时间和VAP发生率明显少于对照组（P均〈0.05）。结论对进行机械通气的COPD患者给予rhGH能纠正患者的营养不良状况,有助于脱机。     

食管癌合并肺功能不全患者术后应用重组人生长激素的临床观察

目的 探讨术后应用重组人生长激素对食管癌合并肺功能不全患者的影响.方法 将79例食管癌合并肺功能不全患者随机分成治疗组和对照组.治疗组术后采用常规静脉营养+肠内营养[总热量35 kal/(kg ·d)]+重组人生长激素(rhGH),其中rhGH每天皮下注射10 U,共计10 d.对照组仅采用常规静脉营养+肠内营养.分别于术后第3、7、10天测定血红蛋白、血浆总蛋白、白蛋白、转铁蛋白,并行双手握力试验,观察机械通气时间、ICU入住时间以及切口感染、吻合口瘘、坠积性肺炎发生率.结果 与对照组比较,治疗组术后第7、10天血红蛋白、血浆总蛋白、白蛋白、转铁蛋白浓度升高,双手握力明显提高,呼吸机辅助时间、ICU 入住时间减少,切口感染、吻合口瘘及坠积性肺炎发生率明显降低(P均＜0.01).结论 与单纯的常规营养相比,rhGH可以明显改善食管癌合并肺功能不全患者术后蛋白质合成代谢,减少术后并发症的发生,促进患者恢复.     

重组人生长激素对COPD患者瘦素水平和营养状况的影响

目的探讨重组人生长激素对COPD患者瘦素水平和营养状况的影响。方法40例COPD急性加重期患者随机分成生长激素组和对照组。均给予抗感染、氧疗、营养支持等。生长激素组在上述治疗基础上加用RhGH，每晚1次皮下注射，连续应用7～10d。观察治疗前后，患者体重指数（BMI）、肱三头肌皮褶（TSF）、上肢臂肌围（MAMC）总蛋白，白蛋白值，瘦素水平，分析相关关系。结果治疗后rhGH组BMI、TSF、AMC．总蛋白，白蛋白值，瘦素水平与治疗前比较差异均有统计学意义。瘦素与BMI、TSF、AMC总蛋白，白蛋白值显著正相关。结论生长激素联合营养支持治疗能提高老年慢性阻塞性肺疾病患者营养状态和瘦素水平。     

体温控制对重型颅脑损伤患者血清NSE、ET-1及近期预后的影响

目的探讨体温控制对重型颅脑损伤患者血清神经元特异性烯醇化酶（NSE）、内皮素1（ET-1）及近期预后的影响。方法将48例重型颅脑损伤患者随机分为两组各24例,治疗组用亚低温治疗仪将患者急性期7 d内的肛温持续控制在36-37℃;对照组未控制体温,当体温超过38℃时予常规方法降温。收集两组入院后第1、3、7天的血清标本,用放免法检测NSE和ET-1水平。结果治疗组第3、7天的NSE和ET-1浓度均低于对照组（P均〈0.05）。根据伤后3-6个月的GOS评分,治疗组预后良好率高于对照组（P〈0.05）。结论体温控制在36-37℃可降低重型颅脑损伤患者血清中的NSE、ET-1浓度,降低其预后不良发生率,改善预后。     

重组人生长激素治疗失代偿期肝硬化的疗效分析

目的观察重组人生长激素（rhGH）治疗失代偿期肝硬化的疗效。方法治疗组30例患者给予rhGH4U皮下注射,1次/d×10天,再1次/隔日×20天;对照组30例患者血清白蛋白〈28g/L者,先用人血白蛋白10g,每日1次,在血清白蛋白上升至32g/L后,则改为每周2～3次,治疗30天。两组其他治疗相同。结果治疗组患者治疗前（10.03±2.06）和治疗结束时（8.80±2.34）与对照组治疗前（10.20±1.97）和治疗结束时（9.27±1.86）CTP评分比较无显著差异（P〉0.05）;但治疗组患者在治疗后1月（7.93±2.30）、2月（7.53±2.27）和3月（7.43±2.51）时的CTP评分均分别低于对照组（9.63±1.47、10.1±1.76、10.6±1.59,P〈0.01）。结论rhGH能够改善失代偿期肝硬化患者的肝脏储备功能。     

重组人生长激素促进胃肠道肿瘤患者术后恢复效果观察

2005年1月～2006年1月，我们给予20例胃肠道肿瘤术后患者外源性重组人生长激素（rhGH），患者血浆白蛋白，前白蛋白、转铁蛋白、纤维连接蛋白和胰岛素样生长因子-1（IGF21）水平均较对照组显著升高。现报告如下。     

强化肠内营养治疗危重病低蛋白血症患者40例疗效观察

将80例危重病低蛋白血症患者随机均分为两组，治疗组采用谷氨酰胺（GIn）和重组人生长激素（rhGH）强化的肠内营养（EN）．对照组采用常规EN，观察两组血清白蛋白变化和病情转归。结果显示．治疗后治疗组血清白蛋白明显升高．对照组无明显变化．两组比较具有显著统计学差异（P〈0．01）。提示强化EN能明显提高患者的血清白蛋白水平，减少并发症和病死率，缩短住院时间。     

重组人生长激素对老年肺部感染患者蛋白代谢的影响

目的　观察重组人生长激素 (rhGH)对老年肺部感染患者GH IGF轴的影响 ,探讨rhGH对老年肺部感染合并低蛋白血症的患者的蛋白代谢的作用。方法　将 2 0例老年肺部感染合并低蛋白血症的患者随机分为GH治疗组和非GH治疗组 ,疗程 1 0d,GH治疗组病人给予rhGH 9IU/d ,于研究前及研究结束后观察血清IGF Ⅰ、IGFBP 1、IGFBP 3、GH、血清免疫球蛋白水平。同时分别于研究前、研究第 6天、研究结束时检测血清总蛋白、白蛋白、前白蛋白、转铁蛋白水平。结果　 (1 )研究结束时 ,GH治疗组的血清GH、IGF Ⅰ、IGFBP 3的水平显著高于研究前 (P <0 0 1 )和非GH治疗组 (P <0 0 5) ,而血清IGFBP 1水平显著低于研究前 (P <0 0 1 )和非GH治疗组 (P <0 0 1 ) ;(2 )研究结束后GH治疗组的血清前白蛋白、转铁蛋白的水平显著高于研究前和非GH治疗组 (P <0 0 1 )。 (3)用药前后血清免疫球蛋白的水平无显著的变化。结论　rhGH可使IGF Ⅰ、IGF BP 3水平增加 ,使IGFBP 1降低 ,从而促进蛋白质的合成 ,改善老年肺部感染患者的蛋白代谢。     

重组人生长激素与白蛋白治疗肝硬化低蛋白血症疗效对比研究

目的探讨重组人生长激素与人血白蛋白对肝硬化低蛋白血症的疗效及特点。方法将36例血清白蛋白含量低于35g/L的肝硬化患者随机分为两组：①生长激素治疗组：给予重组人生长激素4IU,肌注,1次/2日,疗程30天;②白蛋白治疗组：给予20%人血白蛋白100ml,静滴,1次/2日,疗程30天。两组同时给予相同方案的保肝、对症治疗。分别于治疗15天、30天、60天、90天测定各项观察指标。结果治疗组于治疗15天血清白蛋白含量上升（P〈0.05）,治疗30天时两组患者血清白蛋白含量均上升（P〈0.05）,60天后生长激素治疗组血清白蛋白水平升至最高点,白蛋白治疗组则较前降低,两组间差异显著（P〈0.01）：90天后生长激素治疗组血清白蛋白含量仍维持较高水平,且肝功能好转,而白蛋白治疗组降至治疗前水平。结论重组人生长激素与白蛋白制剂均可明显提高肝硬化低蛋白血症患者血清白蛋白水平,但重组人生长激素中远期疗效更好,且在改善肝功能方面更具优势。     

早期营养支持在重度颅脑损伤治疗中的应用效果

目的 观察早期营养支持在重度颅脑损伤患者中的应用效果.方法 将40例重度颅脑损伤患者随机分为观察组和对照组,各20例.观察组术后24 ～48 h内即予肠外±肠内营养支持,能量按25 kcal/( kg·d),氮热比为1∶150 ～200.对照组由家属自行由鼻饲管注入米汤、果汁、牛奶、自制匀浆膳食等肠内营养制剂,静脉营养给予单瓶脂肪乳、氨基酸、5％葡萄糖制剂输注.分别于入院后第1天及营养支持治疗第14天,检测患者的血红蛋白、淋巴细胞计数、血清总蛋白、血清白蛋白及血生化(包括肝肾功能、血糖及电解质),观察并发症发生情况.结果 营养支持治疗14 d后,观察组患者血红蛋白、血清总蛋白、血清白蛋白、淋巴细胞计数等明显上升,与对照组比较,P均＜0.05.观察组出现高血糖1例、腹泻2例、腹胀1例、呕吐反流2例,对照组分别为7、5、6、8例;两组不良反应比较,P ＜0.05.结论 对重度颅脑损伤患者早期实施营养支持,能有效改善患者的营养状况,减少并发症的发生.     

Short-term application of low-dose growth hormone in surgical patients： Effects on nitrogen balance and blood glucose

AIM： To investigate the effectiveness and safety of recombinant human growth hormone （rhGH） in postoperative patients.
METHODS： A total of 48 consecutive patients undergoing abdominal operations were randomized to receive either subcutaneous rhGH （0.15 IU/kg） or placebo （menstruum） injections daily for 7 d after surgery. The two groups had similar nutritional intake. Blood samples for serum fibronecUn, albumin, prealbumin, transferrin and the total lymphocyte count, as well as glucose levels were collected to study the rhGH effect. Basal laboratory evaluation, and nutritional status were estimated on d 1 before as baseline and d 3 and 10 after operation using standard laboratory techniques. Nitrogen balance was measured from d 3 to 9 after operation.
RESULTS： The cumulative nitrogen balance was significantly improved in rhGH group compared with the placebo group （11.37 ± 16.82 vs -9.11 ± 17.52, P = 0.0003）. Serum fibronectin was also significantly higher in the rhGH group than in the placebo group （104.77 ± 19.94 vs 93.03 ± 16.03, P 〈 0.05）, whereas changes in serum albumin, prealbumin, transferrin and total lymphocyte counts were not statistically significant. Mean blood glucose levels were significantly higher in the rhGH group from d 3 to 6 after operation.
CONCLUSION： If blood glucose can be controlled, lowdose growth hormone together with hypocaloric nutrition is effective on improving positive nitrogen balance and protein conservation and safe is in postoperative patients.     

生长激素联合肠内营养改善重症颅脑损伤后昏迷患者营养状态及临床预后的研究

目的研究生长激素（GH）联合肠内营养在改善重症颅脑损伤后昏迷患者营养状态及临床预后的效果。 方法选择南方医科大学顺德医院神经外科自2017年1月1日至2018年10月31日收治的84例重症颅脑外伤后昏迷患者作为研究对象,随机数字表法将患者分成试验组和对照组,每组42例,试验组采用GH联合肠内营养治疗,对照组单纯使用肠内营养,比较2组患者的营养相关血生化指标、免疫功能指标、并发症发生率,以及出院后6个月生活自理能力评估量表评分。 结果试验组患者营养学相关血生化指标前白蛋白、白蛋白、血红蛋白和转铁蛋白水平,免疫功能指标lgA、lgM、lgG均高于对照组,差异有统计学意义（P<0.05）;试验组患者胃肠道并发症发生率,及住院期间泌尿系感染、深静脉血栓的发生率与对照组比较,差异无统计学意义（P>0.05）,但住院期间试验组肺部感染发生率小于对照组,差异有统计学意义（P<0.05）;试验组患者经治疗后6个月时日常生活能力优于对照组,差异有统计学意义（P<0.05）。 结论GH联合肠内营养治疗能够改善重症颅脑损伤后昏迷患者的营养状态,降低并发症发生率,改善远期临床预后。     

Effects of recombinant human growth hormone on remnant liver after hepatectomy in hepatocellular carcinoma with cirrhosis

AIM: To explore the effects of recombinant human growth hormone (rhGH) on the remnant liver after hepatectomy in hepatocellular carcinoma with liver cirrhosis. METHODS: Twenty-four patients with hepatocellular carcinoma who underwent hepatectomy were randomly divided into 2 groups: parenteral nutrition (PN) group (n=12) and rhGH+PN group (n=12). Liver function, blood glucose, AFP, serum prealbumin and transferrin were detected before operation, at post-operative d 1 and d 6. Albumin (ALB) mRNA in liver biopsy specimens was detected by RT-PCR at post-operative d 6. Liver Ki67 immunohistochemical staining was studied. RESULTS: On post-operative d 6, compared with PN group, the levels of blood glucose, serum prealbumin, transferrin, the expression of hepatic ALB mRNA and liver Ki67 labeling index were higher in rhGH+PN group. CONCLUSION: rhGH can improve protein synthesis and liver regeneration after hepatectomy in hepatocellular carcinoma with liver cirrhosis.     

The effects of the formula of amino acids enriched BCAA on nutritional support in traumatic patients

AIM: To investigate the formula of amino acid enriched BCAA on nutritional support in traumatic patients after operation. METHODS: 40 adult patients after moderate or large abdominal operations were enrolled in a prospective, randomly and single-blind-controlled study, and received total parenteral nutrition (TPN) with either formula of amino acid (AA group, 20 cases) or formula of amino acid enriched BCAA (BCAA group, 20 cases). From the second day after operation, total parenteral nutrition was infused to the patients in both groups with equal calorie and equal nitrogen by central or peripheral vein during more than 12 hours per day for 6 days. Meanwhile, nitrogen balance was assayed by collecting 24 hours urine for 6 days. The markers of protein metabolism were investigated such as amino acid patterns, levels of total protein, albumin, prealbumin, transferrin and fibronectin in serum. RESULTS: The positive nitrogen balance in BCAA group occurred two days earlier than that in AA group. The serum levels of total protein and albumin in BCAA group were increased more obviously than that in AA group. The concentration of valine was notably increased and the concentration of arginine was markedly decreased in BCAA group after the formula of amino acids enriched BCAA transfusion. CONCLUSION: The formula of amino acid enriched BCAA may normalize the levels of serum amino acids, reduce the proteolysis, increase the synthesis of protein, improve the nutritional status of traumatic patients after operation.     

生长激素对脑出血大鼠血清白蛋白含量和小肠黏膜形态学的影响

目的 评价重组人生长激素(recombinant human growth hormom,rhGH)对脑出血大鼠血清白蛋白水平和小肠黏膜形态学的影响.方法 采用自体血注射法制作大鼠脑出血模型.56只SD大鼠分为假手术组(n=8),rhGH组(n=24;腹腔注射rhGH,1 U/kg,1次/d)和生理盐水对照组(n=24;腹腔注射等量生理盐水,1次/d),后两组均分别再分为术后1、7和14 d组(每组n=8).检测各组大鼠不同时问点血清白蛋白浓度,HE染色和图像分析观察小肠黏膜形态学改变.结果 脑出血各时间点,生理盐水对照组血清白蛋白水平均较假手术组显著降低(P均<0.01);rhGH组血清白蛋白水平随治疗进程逐渐增高,但仅在14 d时显著高于生理盐水对照组[(39.93±1.98)g,L对(37.93±1.57)g,L,P<0.01].脑出血后1 d和7 d时,rhGH组小肠绒毛高度和黏膜厚度与生理盐水对照组无显著差异,但14 d时显著增高(P<0.01).脑出血后1、7和14 d小肠绒毛面积进行性缩小,且rhGH组较生理盐水对照组随治疗进程进行性增高(P<0.01).脑出血后1 d和7 d.rhGH组肠腺深度较生理盐水对照组增高(P<0.01),但14 d时无显著差异;脑出血1 d,rhGH组组肠腺密度较生理盐水对照组显著增高(P<0.01),7 d时增高不显著,14 d时不仅不增反而稍有降低.结论 脑出血大鼠血清白蛋白水平较假手术组显著下降;脑出血可引起小肠黏膜损害.rhGH可提高脑出血大鼠血清白蛋白水平,不论在脑出血早期还是后期均可不同程度减轻小肠黏膜损伤,后期改善更为显著.rhGH对小肠黏膜损伤的改善程度与血清白蛋白水平的升高程度呈正相关.     

早期营养支持对≥70岁冠状动脉旁路移植术患者的效果分析

目的观察术后早期营养支持对≥70岁冠状动脉旁路移植术患者预后的影响。方法选取2015年6月至2018年12月期间邢台市第三医院≥70岁冠状动脉旁路移植术患者222例,随机分为对照组(n=111)和试验组(n=111),对照组术后仅口服营养,试验组除口服营养外术后第1天开始给予肠外营养进行补充。对两组患者术后总蛋白(total protein,TP)、清蛋白(albumin,ALB)、前清蛋白(prealbumin,PAB)、转铁蛋白(transferrin,TRF)、并发症等方面进行对比分析。结果两组患者术后TP、ALB、PAB、TRF浓度均较术前下降,差异有统计学意义(P<0.05),对照组较试验组下降更明显。两组患者术后第7天TP、ALB浓度比较,差异有统计学意义(P<0.05);术后第3、7天PAB、TRF浓度比较,差异有统计学意义(P<0.05)。试验组术后并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论对≥70岁冠状动脉旁路移植术后患者早期联合肠外、肠内营养支持效果明显优于单纯肠内营养支持,可以有效改善其术后各项营养指标,并降低不良临床结局的发生率。     

Combined human growth hormone and lactulose for prevention and treatment of multiple organ dysfunction in patients with severe chronic hepatitis B

AIM: To evaluate the efficiency and safety of combined recombinant human growth hormone (rhGH) and lactulose for treatment and/or prevention of multiple organ dysfunction in patients with chronic severe hepatitis B. METHODS: Forty-eight inpatients with chronic severe hepatitis B were randomly divided into rhGH group (n = 28) and control group (n = 20). In rhGH group, 4-4.5 IU of rhGH was injected intramuscularly once daily for 2-4 wk, and 100 mL of enema containing 30 mL of lactulose, 2 g of metronidazole and 0.9% saline was administered every 2 d for 2-4 wk. Their symptoms and complications were noted. Liver and kidney functions were analyzed by an Olympus analyzer. Serum GH, IGF-1, IGFBP1 and IGFBP3 were measured by ELISA. RESULTS: Clinical symptoms of 90% of these patients in rhGH group were obviously improved. The total effectiveness in rhGH group was better than that in control group (75% vs 40%, P<0.05). After 2- and 4-wk treatment of rhGH respectively, serum albumin (26.1±4.1 vs 30.2±5.3, 31.9±5.1 g/L), prealbumin (79.6±28.0 vs 106.6±54.4, 108.4±55.0 g/L), cholesterol (76.3±16.7 vs 85.6±32.3, 96.1±38.7 mg/dL), and IGFBP1 (56.8±47.2 vs 89.7±50.3 ng/mL after 2 wk) were significantly increased compared to control group (P<0.05). However, serum GH was decreased. The increase of serum IGF1 and IGFBP3 after rhGH treatment was also observed. CONCLUSION: rhGH in combination with lactulose may be beneficial to the prevention and treatment of multiple organ dysfunction in patients with chronic severe hepatitis.     

重组人生长激素治疗慢性肝病低蛋白血症的临床观察

目的　探讨重组人生长激素对慢性肝病低蛋白血症的治疗效果。方法　 5 6例慢性肝病患者随机分为治疗组 2 8例和对照组 2 8例 ,在相同的护肝治疗基础上 ,治疗组应用重组人生长激素 4U ,皮下注射 ,每日一次 ,连续应用 14天。对照组应用 2 0 %人血白蛋白 5 0ml ,静脉滴注 ,每日一次 ,连续应用 14天。观察治疗前 ,治疗结束当天 ,治疗结束后 14天的临床症状及肝功能的改善情况。结果　治疗组的白蛋白治疗前为 2 7.12± 4.0 6g/L ,治疗结束当天为 3 1.45± 4.76g/L ,治疗结束后 14天为 3 1.6± 4.62g/L ;对照组的白蛋白治疗前为 2 6.88± 4.68g/L ,治疗结束当天为 3 3 .3 5± 5 .84g/L ,治疗结束后 14天为 2 8.42± 3 .84g/L。结论　重组人生长激素可有效地改善慢性肝病患者的低蛋白血症。     

Human serum proteins indicative for the nutritional status and serum proteinase inhibitors in uncomplicated falciparum malaria

The serum proteins supposed to be indicative of the nutritional status, albumin, prealbumin and transferrin, as well as the serum proteinase inhibitors alpha 1-protease inhibitor (alpha 1-antichymotrypsin (Ach) and alpha 2-macroglobulin (alpha 2M) were measured in 14 Thai males suffering from uncomplicated falciparum malaria on the day of admission and after treatment with mefloquin on the 2nd, 28th and 63rd day. The same serum proteins had been determined from 31 healthy Thai males. Upon admission albumin and prealbumin concentrations had been lower and Ach higher in malaria patients compared with healthy Thai males. A significantly higher alpha 1 PI value was observed on the day of admission compared with the 28th day of the malaria patients. Only on the day of admission and only for the patients was a statistically significant negative linear regression found for albumin and prealbumin with Ach and a positive correlation for prealbumin with alpha 2 M as well as for albumin and transferrin correlated with alpha 1 PI. In well-nourished malaria patients the synthesis of the "acute phase reactants", alpha 1 PI and Ach, might be enhanced and in a reverse relationship the synthesis of albumin, pre-albumin and transferrin depressed.     

鼻空肠与鼻胃管管饲的急性重症卒中患者的肺炎

目的 探讨鼻空肠管与鼻胃管肠内营养支持对重症急性卒中患者卒中相关性肺炎(stroke associated pneumonia,SAP)以及其他并发症的影响.方法 共纳入60例需要管饲的重症急性卒中患者,随机分为鼻空肠管组和鼻胃管组进行肠内营养支持,观察2周内SAP、腹泻、呕吐、消化道出血和低钠血症的发生,记录置管前以及置管后7d和14 d时的营养指标(总蛋白、前白蛋白、血红蛋白)并进行比较.结果 鼻空肠管组和鼻胃管组各30例,2组人口统计学和基线临床资料均无显著差异.鼻空肠管组SAP(43.3％对70.0％;x2=4.340,P=0.037)、呕吐(13.3％对43.3％x2 =6.648,P=0.010)和低钠血症(16.7％对40.0％;x2 =4.022,P=0.045)发生率显著低于鼻胃管组,但腹泻和消化道出血发生率无显著差异.鼻空肠管组置管后14 d时的血浆总蛋白和前白蛋白浓度与置管前无显著差异,但血红蛋白浓度显著降低(P=0.001);相比之下,鼻胃管组置管后14 d时血浆总蛋白(P=0.001)、前白蛋白(P=0.036)和血红蛋白(P=0.001)浓度与置管前相比均显著降低.结论 重症急性卒中患者鼻空肠肠内营养能有效预防SAP以及呕吐和低钠血症的发生,并且有助于维持患者的营养状况.