危重病人GH与TF变化的临床意义

Clinical Significance of Changes of Serum GH and TF Levels in Critical Patients

目的:探讨生长激素(GH)和血清转铁蛋白(TF)对危重病人营养代谢的影响。方法:根据APACHE-Ⅱ评分标准,对不同病情(普通A组、危重B组、极危重C组)患者测定血清转铁蛋白及生长激素值,并对B组和C组的患者在疾病恢复期进行复查。结果:C组患者血清转铁蛋白水平低于B组,B组患者低于A组。B组病人的生长激素水平明显高于A组,C组病人与另两组差异均无显著性。进入恢复期后,患者血清转铁蛋白水平明显上升,而生长激素水平无明显下降。结论:急性危重症患者大多存在急性能量-蛋白质营养不良,并引起内分泌紊乱。血清转铁蛋白水平可反映患者营养状况及患者病情危重程度。

Objective To investigate the relationship between serum GH, TF levels and the nutritional status of critically ill patients. Methods Serum GH （with RIA） and TF （with immuno -turbidmetry） levels were determined in 72 ICU patients. These patients were of 3 groups： Group A n =32, APACHE -Ⅱ seore≤20, Group B, n =32, very critical, APACHE -Ⅱ score 〉20; Group C, n = 8, extremely critical, APACHE -Ⅱ score ≥30. Survivors of Group B and Group C patients （n = 28） had their serum levels determined again 2 wks later. Results Originally, the levels of serum TF were lowest in Group C and highest in Group A （difference between groups, P 〈 0.01 ）. For GH, the levels were highest in Group B （vs Group A, P 〈 0. 05 ） with levels in Group C moderately but not significantly higher than those in Group A. At the second determination, all the 28 patients recovered well. Their APACHE -Ⅱ scores were 〈 20 and serum TF levels were significantly higher than those of the first determination （P 〈 0.01 ） but with no significantly drop of serum GH levels （ P 〉 0. 05）. Conclusion There was acute energy - protein malnutrition in critically ill patients with endocrine disturbances. Serum TF levels correlated well with the nutritional status and might reflect the severity of the disease.