Douglas R G, Humberstone D A, Haystead A, Shaw J H
Department of Surgery, Auckland Hospital, New Zealand.
Br J Surg. 1990 Jul;77(7):785-90. doi: 10.1002/bjs.1800770722.
We have performed a series of isotopic studies in 25 adult patients with sepsis and/or trauma in order to determine the metabolic effects of recombinant human growth hormone (rHGH) administration. Twelve of the patients were receiving total parenteral nutrition, and 13 were eating a normal ward diet and were studied postabsorption. Energy and protein kinetics were quantified isotopically before rHGH administration and following a 3-day course of rHGH (20 units subcutaneously daily). In the total parenteral nutrition group the rate of net loss of protein decreased from 0.82(0.17) g kg-1 day-1 to 0.43(0.20) g kg-1 day-1 (P less than 0.02) following the administration of rHGH. The rate of appearance of leucine was not altered, suggesting that the improvement in nitrogen balance following rHGH was because of an increased rate of protein synthesis rather than reduced catabolism. In the postabsorptive group, rHGH treatment significantly increased the rate of appearance of free fatty acids (from 7.4(2.2) mumol kg-1 min-1 to 11.1(2.6) mumol kg-1 min-1, P less than 0.03) and free fatty oxidation (from 1.3(0.4) mumol kg-1 min-1 to 1.7(0.4) mumol kg-1 min-1, P less than 0.06), while the rate of leucine oxidation was reduced (from 0.44(0.05) mumol kg-1 min-1 to 0.26(0.03) mumol kg-1 min-1, P less than 0.005). Glucose appearance and oxidation remained unchanged. These results suggest that fat was being oxidized in preference to protein, which resulted in a reduction in the net rate of loss of protein of 0.3 g kg-1 day-1 (P less than 0.05). We conclude that rHGH administration is capable of significantly reducing net protein loss in septic or injured surgical patients. Recombinant HGH may be clinically useful in supporting critically ill surgical patients who require intensive nutritional support.
我们对25例患有败血症和/或创伤的成年患者进行了一系列同位素研究，以确定给予重组人生长激素（rHGH）的代谢效应。其中12例患者接受全胃肠外营养，13例患者食用普通病房饮食且在吸收后进行研究。在给予rHGH之前以及经过3天的rHGH疗程（每天皮下注射20单位）后，通过同位素定量能量和蛋白质动力学。在全胃肠外营养组中，给予rHGH后蛋白质净丢失率从0.82（0.17）g·kg⁻¹·d⁻¹降至0.43（0.20）g·kg⁻¹·d⁻¹（P<0.02）。亮氨酸的出现率未改变，这表明rHGH治疗后氮平衡的改善是由于蛋白质合成速率增加而非分解代谢减少。在吸收后组中，rHGH治疗显著增加了游离脂肪酸的出现率（从7.4（2.2）μmol·kg⁻¹·min⁻¹增至11.1（2.6）μmol·kg⁻¹·min⁻¹，P<0.03）和游离脂肪酸氧化率（从1.3（0.4）μmol·kg⁻¹·min⁻¹增至1.7（0.4）μmol·kg⁻¹·min⁻¹，P<0.06），而亮氨酸氧化率降低（从0.44（0.05）μmol·kg⁻¹·min⁻¹降至0.26（0.03）μmol·kg⁻¹·min⁻¹，P<0.005）。葡萄糖的出现率和氧化率保持不变。这些结果表明脂肪优先于蛋白质被氧化，这导致蛋白质净丢失率降低了0.3g·kg⁻¹·d⁻¹（P<0.05）。我们得出结论，给予rHGH能够显著降低脓毒症或受伤手术患者的蛋白质净丢失。重组HGH在支持需要强化营养支持的重症手术患者方面可能具有临床应用价值。
