胰岛素样生长因子-I与生长激素联合治疗对急性创伤性脑损伤患者的全身代谢影响。

Systemic metabolic effects of combined insulin-like growth factor-I and growth hormone therapy in patients who have sustained acute traumatic brain injury.

作者信息

Hatton Jimmi, Kryscio Richard, Ryan Melody, Ott Linda, Young Byron

机构信息

Colleges of Pharmacy, Public Health, and Medicine, University of Kentucky, Lexington, Kentucky 40536-0509, USA.

出版信息

J Neurosurg. 2006 Dec;105(6):843-52. doi: 10.3171/jns.2006.105.6.843.

DOI:10.3171/jns.2006.105.6.843

PMID:17405254

Abstract

OBJECT

Hypermetabolism, hypercatabolism, refractory nitrogen wasting, hyperglycemia, and immunosuppression accompany traumatic brain injury (TBI). Pituitary dysfunction occurs, affecting growth hormone (GH) and plasma insulin-like growth factor-I (IGF-I) concentrations. The authors evaluated whether combination IGF-I/GH therapy improved metabolic and nutritional parameters after moderate to severe TBI.

METHODS

The authors conducted a prospective, randomized, double-blind study comparing combination IGF-I/GH therapy and a placebo treatment. Ninety-seven patients with TBI were enrolled in the study within 72 hours of injury and were assigned to receive either combination IGF-I/GH therapy or placebo. All patients received concomitant nutritional support. Insulin-like growth factor-I was administered by continuous intravenous infusion (0.01 mg/kg/hr), and GH (0.05 mg/kg/day) was administered subcutaneously. Placebo control group patients received normal saline solution in place of both agents. Nutritional and metabolic monitoring continued throughout the 14-day treatment period. The two groups did not differ in energy expenditure, nutrient intake, or use of insulin treatment. The mean daily serum glucose concentration was higher in the treatment group (123 +/- 24 mg/dl) than in the control group (104 +/- 11 mg/dl) (p < 0.03). A positive nitrogen balance was achieved within the first 24 hours in the treatment group and remained positive in that group throughout the treatment period (p < 0.05). This pattern was not observed in the control group. Plasma IGF-I concentrations were above 350 ng/ml in the treatment group throughout the study period. Overall, the mean plasma IGF-I concentrations were 1003 +/- 480.6 ng/ml in the treatment group and 192 +/- 46.2 ng/ml in the control group (p < 0.01).

CONCLUSIONS

The combination of IGF-I and GH produced sustained improvement in metabolic and nutritional endpoints after moderate to severe acute TBI.

摘要

目的

创伤性脑损伤（TBI）伴有高代谢、高分解代谢、难治性氮消耗、高血糖和免疫抑制。垂体功能出现障碍，影响生长激素（GH）和血浆胰岛素样生长因子-I（IGF-I）浓度。作者评估了IGF-I/GH联合治疗是否能改善中重度TBI后的代谢和营养参数。

方法

作者进行了一项前瞻性、随机、双盲研究，比较IGF-I/GH联合治疗与安慰剂治疗。97例TBI患者在受伤后72小时内纳入研究，并被分配接受IGF-I/GH联合治疗或安慰剂治疗。所有患者均接受了营养支持。胰岛素样生长因子-I通过持续静脉输注给药（0.01mg/kg/小时），GH（0.05mg/kg/天）皮下给药。安慰剂对照组患者接受生理盐水代替两种药物。在整个14天的治疗期间持续进行营养和代谢监测。两组在能量消耗、营养摄入或胰岛素治疗使用方面无差异。治疗组的平均每日血清葡萄糖浓度（123±24mg/dl）高于对照组（104±11mg/dl）（p<0.03）。治疗组在最初24小时内实现了正氮平衡，并在整个治疗期间持续保持正氮平衡（p<0.05）。对照组未观察到这种模式。在整个研究期间，治疗组的血浆IGF-I浓度均高于350ng/ml。总体而言，治疗组的平均血浆IGF-I浓度为1003±480.6ng/ml，对照组为192±46.2ng/ml（p<0.01）。