腹部手术后使用生长激素可减少接受全胃肠外营养患者的前臂谷氨酰胺、丙氨酸、3-甲基组氨酸和总氨基酸流出量。

Growth hormone after abdominal surgery attenuated forearm glutamine, alanine, 3-methylhistidine, and total amino acid efflux in patients receiving total parenteral nutrition.

作者信息

Mjaaland M, Unneberg K, Larsson J, Nilsson L, Revhaug A

机构信息

Department of Surgery, Tromsø University Hospital, Norway.

出版信息

Ann Surg. 1993 Apr;217(4):413-22. doi: 10.1097/00000658-199304000-00014.

DOI:10.1097/00000658-199304000-00014

PMID:8466313

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1242809/

Abstract

OBJECTIVE

The study clarified the effects of growth hormone treatment on forearm amino acid efflux in patients with full nutritional support after gastrointestinal surgery.

SUMMARY BACKGROUND DATA

Growth hormone attenuates net nitrogen loss after surgical trauma. An increase in net protein synthesis has been described, whereas the results regarding protein breakdown have been conflicting.

METHODS

Elective patients undergoing abdominal surgery were double blindly randomized to treatment with recombinant human growth hormone (GH, n = 9) 24 IU or placebo (PL, n = 10) the first 5 postoperative days. All received parenteral nutrition (nitrogen = 5.7 +/- .1 g/m2, energy = 1018 +/- 12 kcal/m2 (125 +/- .7% of BMR) and epidural analgesia. Amino acid plasma levels and forearm fluxes were measured.

RESULTS

The second postoperative day, growth hormone abolished forearm efflux of total amino acid nitrogen (GH: 170 +/- 117, PL: -785 +/- 192 nmol/100 mL/min, p = .0007) due to reduced losses of both essential and nonessential amino acids. Glutamine release was abolished (13 +/- 15 vs. -137 +/- 43 nmol/100 mL/min, p = .007) and alanine release attenuated (-61 +/- 17 vs. -211 +/- 51 nmol/100 mL/min, p = .01). 3-Methyl-histidine release was attenuated (-.20 +/- .11 vs. -.62 +/- .09 nmol/100 mL/min, p = .04). Growth hormone also induced decreased venous plasma amino acid levels.

CONCLUSIONS

When given after gastrointestinal surgery in patients treated with total parenteral nutrition, growth hormone treatment abolished glutamine, 3-methylhistidine, and total amino acid nitrogen loss from forearm tissue. Alanine loss from forearm tissue was attenuated.

摘要

目的

本研究阐明了生长激素治疗对胃肠道手术后接受全营养支持患者前臂氨基酸流出的影响。

总结背景数据

生长激素可减轻手术创伤后的净氮损失。已有研究描述了净蛋白质合成增加，而关于蛋白质分解的结果则相互矛盾。

方法

择期接受腹部手术的患者在术后第1至5天被双盲随机分为两组，分别接受重组人生长激素（GH，n = 9）24 IU治疗或安慰剂（PL，n = 10）治疗。所有患者均接受肠外营养（氮= 5.7±0.1 g/m²，能量= 1018±12 kcal/m²（基础代谢率的125±0.7%））和硬膜外镇痛。测量血浆氨基酸水平和前臂通量。

结果

术后第2天，生长激素消除了前臂总氨基酸氮的流出（GH组：170±117，PL组：-785±192 nmol/100 mL/分钟，p = 0.0007），这是由于必需氨基酸和非必需氨基酸的损失均减少。谷氨酰胺释放被消除（13±15对-137±43 nmol/100 mL/分钟，p = 0.007），丙氨酸释放减弱（-61±17对-211±51 nmol/100 mL/分钟，p = 0.01）。3-甲基组氨酸释放减弱（-0.20±0.11对-0.62±0.09 nmol/100 mL/分钟，p = 0.04）。生长激素还导致静脉血浆氨基酸水平降低。