摘要
目的 观察围手术期应用重组人生长激素 (rHGH)对肠外营养病人肠粘膜通透性、小肠粘膜形态、细胞免疫功能和预后的影响。 方法 前瞻性、随机、双盲、安慰剂对照的临床研究。 2 0例因胃肠道疾病行手术治疗的病人进入本研究。术前 3天至术后第 7天 ,研究组病人接受rHGH(0 .3IU·kg-1·d-1,皮下注射 )治疗 ,对照组接受安慰剂。从术前 1天至术后第 6天 ,两组病人接受等氮等热卡的肠外营养 (2 0Kcal·kg-1·d-1,N 0 .15 g·kg-1·d-1)。观察指标包括 :肠粘膜通透性、小肠粘膜形态、外周血淋巴细胞亚群和预后。 结果 (1)rHGH治疗显著提高了研究组病人血浆GH和IGF 1浓度 (P =0 .0 0 93～ 0 .0 2 9) ,而对照组血浆GH和IGF 1浓度较术前无变化 (P =0 .2 5～ 0 .6 9)。(2 )手术后对照组肠粘膜通透性较术前明显升高 (P =0 .0 1) ,研究组升高不明显 (P =0 .0 8)。研究组小肠粘膜厚度和绒毛高度与对照组比较无显著差别 (P =0 .5 4,P =0 .6 6 )。 (3)对照组病人术后CD4+淋巴细胞比例及CD4+/CD8+淋巴细胞比值较术前下降 (P =0 .0 3) ,研究组术后无明显变化 (P =0 .0 9～ 0 .49) ,两组间变化差值比较有显著性差异 (P =0 .0 2 )。 (4)临床未见与rHGH治疗有关的严重不反应。rHGH治疗后研究组空腹血糖较治疗前有升高趋?
Objective To evaluate the effects of rHGH o n intestinal permeability, intestinal morphology and cell immune function. Methods A placebo controlled randomized double blind trial was performed. 20 patients undergoing abdominal surgery were randomized into t wo groups. The patients in the study group received rHGH (0.3IU·kg -1·d -1) subcutaneously from the 3rd day before operation onward to the 7th day a fter operation. The patients in the control group received placebo. All the pati ents were given isonitrogenic (N 0.15g·kg -1·d -1) and isocaloric (2 0 Kcal·kg -1·d -1) parenteral nutrition from the 1st preoperative da y to the 6th postoperative day. The intestinal permeability, peripheral CD4+/CD8 + lymphocyte proportion, blood routine and biochemiscal analysis were determined before and after rHGH treatment. The jejunum biopsy was performed on the operat ion day for the determination of the intestinal morphology. Results 1) GH and IGF 1 levels were similar in the two groups and had not changed significantly in the control group by the 7th postoperative day. In the study group a significant increase in serum levels of GH and IGF 1 was observed on 3rd and 7th postoperative day. 2) The intestinal permeability (L/M) in the c ontrol group was elevated on POD+7 ( P =0.01), whereas the L/M ratio in the st udy group kept the same as preoperative( P =0.08). No significant difference w as observed on the jejunum morphology between the two groups. 3) A significant d ecrease in CD4+ subset proportion and CD4+/CD8+ ratio was observed in the contro l group on the 7th postoperative day, whereas no change was observed in study gr oup. 4) No adverse reaction related with rHGH was observed. Glucose level in the control group was unaltered, but in the study group a trend of rising in glucos e level was observed, which was not significant. 5) There was no significant dif ference in operation related complication and period of hospital stay between t he two groups. Conclusions 1) rHGH prevented the increase of intestinal permeability, preserved intestinal barrier function. 2) rHGH elim inated the depression in cellular immunity following the surgical stress.
出处
《中国临床营养杂志》
2001年第2期77-80,共4页
Chinese Journal of Clinical Nutrition
基金
国家自然科学基金和高教基金支持 (合同号 :3 9970 72 3 )
