Tacke J, Bolder U, Löhlein D
Chirurgische Klinik, Städtische Kliniken Dortmund, FRG.
Infusionsther Transfusionsmed. 1994 Feb;21(1):24-9. doi: 10.1159/000222940.
To examine the effect of recombinant human growth hormone (rhGH) on the catabolic state following major gastrointestinal surgery.
The study was designed as a prospective controlled randomized clinical trial.
Intensive care unit and the surgical ward of the Department of Surgery, Städtische Kliniken Dortmund, FRG.
39 patients were studied postoperatively following gastrectomy or resection of the rectum. The patients were 40-75 years old.
0.075 (n = 11), 0.15 (n = 9) or 0.30 IU rhGH/kg/day (n = 9) or placebo (n = 10) were given subcutaneously at 8:00 a.m. during 5 postoperative days. Resting energy expenditure (REE) on the 1st postoperative day was 2,042 +/- 82 kcal/24 h (REE/BEE 1.44 +/- 0.04). Isocaloric, isonitrogenous total parenteral nutrition provided the energy requirements (4 g carbohydrates/kg, 0.9 g fat/kg, 1.25 g amino acids/kg).
After 5 days of treatment, cumulated nitrogen balance (CNB) was improved dose-relatedly. In controls, net nitrogen losses (-20.47 +/- 3.86 g) were significantly higher than after 0.15 (-12.14 +/- 3.5 g) and 0.30 IU rhGH/kg (-10.0 +/- 2.61 g). 0.075 IU rhGH/kg showed no significant effect on CNB (-18.07 +/- 5.73 g). The modulation of protein metabolism by GH may be mediated by insulin-like growth factor-I (IGF-I). Postoperatively serum (S)-IGF-I was decreased in all groups. rhGH caused a significant dose-related increase in S-IGF-I levels on day 6, whereas in controls it remained unchanged during the study period. Besides significant elevations in serum glucose in some cases of both larger dosage groups no side effects were detected.
The protein-sparing effect of rhGH after major gastrointestinal surgery is dose related but not linear. A threshold value for a significant improvement in the CNB seems to be at least at 0.15 IU rhGH/kg/day.
研究重组人生长激素（rhGH）对胃肠道大手术后分解代谢状态的影响。
本研究设计为前瞻性对照随机临床试验。
德国多特蒙德市立医院外科重症监护病房及外科病房。
39例胃切除术或直肠切除术后患者接受研究。患者年龄在40 - 75岁之间。
术后5天，每天上午8点皮下注射0.075（n = 11）、0.15（n = 9）或0.30 IU rhGH/kg/天（n = 9）或安慰剂（n = 10）。术后第1天静息能量消耗（REE）为2,042 ± 82 kcal/24 h（REE/BEE 1.44 ± 0.04）。等热量、等氮的全胃肠外营养满足能量需求（4 g碳水化合物/kg、0.9 g脂肪/kg、1.25 g氨基酸/kg）。
治疗5天后，累积氮平衡（CNB）呈剂量依赖性改善。对照组净氮损失（-20.47 ± 3.86 g）显著高于0.15 IU rhGH/kg（-12.14 ± 3.5 g）和0.30 IU rhGH/kg（-10.0 ± 2.61 g）组。0.075 IU rhGH/kg对CNB无显著影响（-18.07 ± 5.73 g）。生长激素对蛋白质代谢的调节可能由胰岛素样生长因子-I（IGF-I）介导。术后所有组血清（S）-IGF-I均降低。rhGH使第6天S-IGF-I水平显著剂量依赖性升高，而对照组在研究期间保持不变。除两个较大剂量组部分病例血清葡萄糖显著升高外，未检测到副作用。
胃肠道大手术后rhGH的蛋白质节省作用与剂量相关，但并非线性关系。CNB显著改善的阈值似乎至少为0.15 IU rhGH/kg/天。
