重组人生长激素对烧伤后高代谢反应的调节作用

目的　探讨重组人生长激素 (rhGH)对烧伤后高代谢反应的作用及其机制。　 方法　选择 1998～ 2 0 0 2年笔者单位收治的烧伤面积为 5 0 %～ 90 %TBSA的患者 32例 ,随机分为治疗组 (A组 ,16例 )和对照组 (B组 ,16例 ) ,治疗组伤后 7d开始皮下注射rhGH,用量 0 .2 5U·kg-1·d-1;对照组于相同时相点注射等量等渗盐水。观察注射后两组患者的静息能量消耗 (REE)、非蛋白呼吸商(NPRQ)、糖代谢、氮平衡、内分泌激素及炎症介质水平变化。　 结果　A组NPRQ于伤后 7d开始增高 ,到 2 1d为 0 .80± 0 .0 9;血浆前列腺素E2 、血栓素B2 、肿瘤坏死因子α、白细胞介素 6显著降低 ;胰岛素、生长激素 (GH)、胰岛素样生长因子Ⅰ (IGF Ⅰ)显著升高 ,伤后累积氮丢失明显低于B组。A组肾上腺素、皮质醇、胰高血糖素明显高于B组 (P <0.0 5 )。　 结论　伤后适时应用rhGH可调节严重烧伤患者的高代谢反应 ;通过增加机体GH、IGF Ⅰ及胰岛素 ,可促进蛋白质合成 ,改善营养状况 ,促进烧伤创面愈合。

Modulation Effects of Recombinant Human Growth Hormone on Postburn Hypermetabolism in Burn Patients

OBJECTIVE: To explore the effects of recombinant human growth hormone (rhGH) on postuburn hypermetabolism in burn patients and its mechanism. METHODS: Thirty-two patients inflicted with burn of 50% to 90% TBSA admitted to our department during past 5 years (1998-2002) were enrolled in the study and randomly divided into A (with 0.25 U.kg(-1).d(-1) of rhGH treatment on 7-10 PBD, n=16) and B (with 0.25 U.kg(-1).d(-1) of normal saline as control, n = 16) groups. The changes in the rest energy expenditure (REE), non-protein respiratory quotient (NPRQ), glucose metabolism, nitrogen balance as well as plasma levels of endocrines and inflammatory mediators were determined before and after the administration of rhGH. RESULTS: rhGH was given to patients in group A during 7 - 10 PBD. The NPRQ in group A began to increase at the 7th PBD, raised to 0.80 +/- 0.09 in the 21st PBD. The plasma levels of PGE2, TXB2, TNF-alpha and IL-6 significantly decreased and insulin, rhGH and IGF-1 obviously increased when compared with those in group B. The accumulated nitrogen loss in group A was also much lower than that in group B. The plasma levels of adrenaline, cortisol, glucagon in group A were significantly higher than those in group B (P < 0.05). CONCLUSION: The postburn administration of rhGH timely could regulate postburn hypermetabolism in severely burned patients by increasing the plasma levels of GH, IGF-1 and insulin, which was beneficial to the improvement of nutrition state and to the promotion of protein synthesis and wound healing.