重组人生长激素对肝移植术后早期营养状态及免疫功能影响的前瞻性研究

目的 评价重组人生长激素（rhGH）结合营养支持治疗在肝移植术后早期对患者营养状态及免疫功能的影响,观察其对肝功能、急性排斥反应及感染发生率是否具有影响,以及临床应用的安全性。方法 60例良性终末期肝病患者于肝移植前被随机分为治疗组（n=30）及对照组（n=30）。两组术后均予营养支持及免疫抑制剂治疗,其中治疗组于术后24h给予rhGH（思增）10U/d皮下注射10d。于术后1、4、8和14d采集静脉血,观察转铁蛋白、前白蛋白、白蛋白、尿素氮等营养指标;CD4/CD8、免疫球蛋白G（IgG）、IgM、IgA等免疫指标;生长激素（GH）、胰岛素样生长因子-1（IGF-1）、天冬氨酸转氨酶（AST）、丙氨酸转氨酸（ALT）水平;维持血糖安全范围（8~10mmol/L）所需胰岛素用量;术后28d内急性排斥反应发生率（肝穿活检）及感染发生率。结果与对照组比较,治疗组14d内转铁蛋白、前白蛋白、CD4/CD8、GH、IGF-1水平显著升高（P均〈0.05）,尿素氮水平明显下降（P〈0.05）;治疗组术后4d和8d控制血糖所需外源性胰岛素用量明显大于对照组（P均〈0.05）;术后14d白蛋白使用量明显低于对照组（P〈0.05）;两组14d内AST、ALT水平及28d内急性排斥反应和感染发生率比较差异均无显著性。结论 在使用免疫抑制剂的前提下,rhGH结合营养支持治疗可以加速改善肝移植术后患者的营养不良,未体现提高机体免疫力的优势,对术后移植肝功能恢复、急性排斥反应及感染发生率未见显著影响。由于其所致血糖升高降低了其安全性。

Prospective study of effect of recombinant human growth hormone on nutritional status and immune function in early postoperative stage of liver transplantation

OBJECTIVE: To evaluate influence of recombinant human growth hormone (rhGH) on nutritional status and immune function in early postoperative stage of liver transplantation including hepatic function, acute rejection and infection rate, in order to assess its safety in clinical use. METHODS: Sixty patients with non-malignant diseases of the liver in terminal stages were randomly divided into two groups: treatment group (rhGH treatment n=30) and control group (n=30). All the patients received the same nutritional support and immunodepressant treatment regimes. The patients in treatment group received rhGH 10 U hypodermically daily for 10 days 24 hours after liver transplantation. The following parameters including siderophilin, prealbumin, albumin, urea nitrogen, CD4/CD8, immunoglobulin G (IgG), IgM, IgA, growth hormone (GH), insulin-like growth factor-1 (IGF-1), aspartate aminotransferase (AST), alanine aminotransferase (ALT), dosage of insulin to control blood sugar (8-10 mmol/L) were determined on 1st, 4th, 8th, 14th days after the operation, and acute rejection rate after 28 days of operation (confirmed by liver acupuncture biopsy), and infection rate were also assessed. RESULTS: Compared with control group, levels of siderophilin, prealbumin, CD4/CD8, GH, IGF-1 within 14 days in treatment group were increased significantly 14 days after the operation (all P<0.05), and level of urea nitrogen was decreased significantly (P<0.05). The level of albumin in treatment group was lower than that in control group 14 days after operation (P<0.05), while dosages of exogenous insulin were higher on 4th and 8th days after operation than that in control group (both P<0.05). There were no significant differences in levels of AST, ALT within 14 days, or acute rejection rate and infection rate within 28 days between two groups (all P>0.05). CONCLUSION: rhGH can accelerate recovery of nutritional status in the early liver transplantation period. It does not show superiority in improving immune function and influence on recovery of hepatic function, acute rejection or infection rate. The safety has been challenged by inducing high blood sugar as a side effect.