术后应用生长激素对血尿氨基酸代谢的影响

Effect of Recombinant Growth Hormone on Amino Acids Metabolism in Blood and Urine after Major Operation

前瞻性研究手术后患者应用重组生长激素对氨基酸代谢的影响。两组患者摄入等量的热卡和氮量，研究组术后给生长激素0．15IU／（kg·d），对照组给安慰剂。与手术前比较，术后第7天两组患者血浆总氨基酸值略有增加，但无统计学差异。对照组术后第7天的谷氨酰胺有所下降，而研究组基本维持术前水平。前臂肌的氨基酸“动-静协差”（A-V）研究表明，两组间有显著性差异，研究组的总氨基酸氮和支链氨基酸、谷氨酰胺的“A－V”表现为摄取，而对照组却为释放（总氨基酸氮的“A－V”是十165士61比一398土158μmol／L，P＜0.01）；给生长激素后，研究组前臂肌肉摄取了更多的氨基酸，而对照组则表现为氨基酸的流失。尿3-甲基组氨酸的排出对照组大于研究组（7.3士1.0比4.4士0.3μmol／（kg·d），P＜0．05）。证实手术后应用生长激素能增加前臂肌的氨基酸摄取，减少尿3-甲基组氨酸的排出，同时不会改变血浆氨基酸的平衡。

To determine the effects of recombinant human growth hormone (GH) on postoperative amino acids metabolism, we performed a placebo-controlled randomized double-blind trial in 18 patients after elective gastrectomy or colectomy.The same amount of calories and amino acids were administered. Research group was daily injected growth hormone 0. 15 IU/(kg. day) and control group was given placebo during the first postoperative week. All urine wereanalyzed for nitrogen balance and excretion of 3-methylhlstidine. On the seventh postopera-tive day while the parenteral nutrients were being infused, amino acid exchange across the forearm was measured. On the seventh postoperative day all patlents' amino acids in plasma were slightly increased by comparing with preoperative day but was not statistical signifi-cance. Forearm arterial-venous difference (A-V) measured on POD+7 was markedly differ-ent between groups. There was continued release of amino acids from the forearm in the con-trol subjects, while there was marked amino acid uptake in the GH patients (total amino acid nitrogen exchange was - 398±158μmol/Lvs + 165±61μmol/L, P<0.01 ). Excretion of urinary 3-methylhistidine in control group loss more than in GH group (7. 3±1.0μmol/(kg ·24h) vs 4. 4±0. 3 μmol/(kg·24h), P<0.05). The results demonstrated that GH can in-crease the uptake of amino acid from forearm and decrease the excreation of 3-methylhis-tidine in urine after operation, but did not disturb the balance of amino acids in plasma-