手术前开始应用生长激素对肠外营养病人蛋白质代谢、肌肉功能、肠粘膜屏障和细胞免疫功能的影响

生长激素(GH)在术后应用已有报告，其代谢效应在术后3～4天出现，为探索创伤后分解代谢的进一步改善，术前开始应用重组人生长激素(rHGH)。目前国内外均无术前应用rHGH的报告。

The impact of preoperative treatment of recombinant human growth hormone on protein metabolism, muscle function, intestinal barrier function and cell immune function

Objective 1. To determine if the positive nitrogen balance could be achieved in early postoperative period by the pretreatment of rHGH. 2. To evaluate the effects of rHGH on intestinal permeability, intestinal morphology and cell immune function. Methods A placebo-controlled randomized double-blind trial were performed. 20 patients undergoing abdominal surgery were randomized into two groups. The patients in the study group received rHGH (0.3IU/kg/day) subcutaneously from the 3rd day before operation onward to the 7th day after operation. The patients in the control group received placebo. All the patients were given isonitrogenic (0.15g N/kg/day) and isocaloric (20Kcal/kg/day) parenteral nutrition from the 1st preoperative day to the 6th postoperative day. The Nitrogen balance and cumulative nitrogen balance were calculated during the 6 postoperative days. The body weight, hands grip strength, and the time requested to walk 20 meters were evaluated, the plasma glutamine level, peripheral CD /CD lymphocyte proportion, blood routine and biochemistry analysis, intestinal permeability were determined before and after rHGH treatment. A jejunum biopsy was performed on the operation day for the determination of the intestinal morphology. Results 1) The positive nitrogen balance was achieved from the 2nd postoperative day onward with the pretreatment of rHGH, whereas the negative nitrogen balance lasted during the postoperative 6 days in the control group. The cumulative nitrogen balance in the study group was significantly better than that in the control group (P<0.01). 2) In the control group, body weigh, hands grip strength decreased,and the time requested to walk 20 meters increased significantly compared to the preoperative level ( P<0.05). In the study group, there were no significant changes on the 7the postoperative day ( P<0.05). The changes between the two groups were significantly different(P<0.05). 3) GH and IGF-I levels were similar in the two groups and had not significantly changed in the control group by the 7th postoperative day. In the study group a significant increase in serum levels of GH and IGF-I was observed on the 3rd and the 7th postoperative day. 4) The plasma glutamine level in control group decreased on POD + 7 compared to preoperative level (P<0.05), and the level of glutamine in the study group did not change ( P<0.05).5) A significant decrease in CD subset proportion and CD /CD ratio was observed in the control group on the 7th postoperative day, whereas no change was observed in study group.6) The intestinal permeability (L/M) in the control group was elevated on POD + 7 (P<0.05), whereas the L/M ratio in the study group kept the same as preoperative. 7) Glucose level in the control group was unaltered, but in the study group a trend of rise in glucose level was observed, which was not significant. 8)No adverse reaction related with rHGH was observed. Conclusions 1 )rHGH combined with parenteral nutrition could overcome the protein catabolic effects of the stress response, and maintain the muscle function. 2)rHGH prevented the increase of intestinal permeability, preserved intestinal barrier function. 3)rHGH eliminated the depression in cellular immunity following the surgical stress.