生长激素治疗失代偿性肝硬化的疗效观察

Clinical Study on the Effcacy of Recombinant Human Growth Hormone in Treating Patients with Decompensated Liver Cirrhosis

目的:观察重组人生长激素(rhGH)对失代偿性肝硬化(DLC)的疗效及其作用机制。方法:32例失代偿性肝硬化患者随机分为2组,对照组17例,给予一般对症治疗;治疗组15例,在对症治疗基础上加用重组人生长激素(rhGH)8 IU皮下注射,1次/d,连用10 d为1个疗程,休息1周后再用1疗程。分别在治疗前、后观察肝功能、胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白(IGFBP-3)、白细胞介素-4(IL-4)和γ干扰素(IFNγ)的变化;肝功能用生化法检测,IGF-1与IGFBP-3用IRMA检测,IL-4与IFNγ用放免法检测。结果:治疗组临床症状改善较快,腹水消退明显,凝血酶元时间(PT)显著缩短,血浆白蛋白显著增加,IGF-1I、GFBP-3和IFNγ有升高倾向,血清IL-4水平略有下降;而对照组上述指标均无明显改善。结论:rhGH能克服GH抵抗,改善GH/IGF-1轴的功能,促进白蛋白合成,并能调节免疫,适用于失代偿性肝硬化病人。

Objective： To evaluate the therapeutic efficacy of recombinant human growth hormone （rhGH）in patients with decompensated liver cirrhosis （DLC） and its possible mechanism. Methods：Thirty-two cases were divided into two groups, one（rhGH group）received subcutaneous injection of rhGH 8 IU daily for 10 days in addition to symptomatic therapy,with one week interT val,then received another course of rhGH; while the other（control group） received symptomatic treatment alone. Liver function, insulin-like growth factor-1（IGF-1） , IGF binding protein-3 （IGFBP-3）, interleukin-4（IL-4） and interferon gamma（IFN-γ） were serially detected before and after therapy by biochemistry,IRMA and RIA methods respectively. Results：Compared with control group,patients received rhGH improved more rapidly in appetite, fatigue, flatulence ,ascites and prothrombin time（PT） . Besides, there was a remarkable increase in plasma albumin level, and serum IGF-1,IGFBP-3 and IFNyconcentrations tend towards rise, serum IL-4 level decreased slightly which was not found in control group. Conclusion： recombinant human growth hormone would be able to overcome GH resistance,improve the function of GH/IGF-1 axis,promote protein synthesis, regulate immune function, and hence, may be good to decompensated cirrhotic patients.