重组人生长激素联合谷氨酰胺治疗轻体重危重患者的临床观察

Clinicl Observation of Recombinant Human Growth Hormone Combined Glutamine in the Treatment on the Light Weight Critically Ill Patients

探讨重组人生长激素(rhGH)联合谷氨酰胺治疗对轻体重危重患者正氮平衡、血糖及体液免疫功能的影响。方法:选择40例符合轻体重(BMI<18.5kg/m^2)诊断标准的综合重症医学科危重症患者为研究对象,将所有患者随机分为两组,即对照组(n=20)、rhGH组(n=20)。rhGH组在营养支持治疗的基础上皮下注射rbGH(思真,默克雪兰诺公司)0IU,每日一次,连用7天后改为隔日一次,再连用2周。对照组经给予相同方案的营养支持治疗。分别观察两组治疗前、治疗后第8、21天人体尿素氮、血糖及体液免疫IgA、IgG、IgM水平的变化。结果:rhGH治疗后在8天和21天,rhGH组BUN值均较同时间对照组值显著降低,其中rhGH组第21天BUN值较第8天下降明显;观察的前7天两组白蛋白输注量无差异,而第8天至第21天的rhGH组输注重显著小于对照组;第21天,rhGH组IgA、IgG较第1天、第8天及对照组有显著升高,IgM在治疗前后各组间比较,差异无显著意义;注射生长抑素后,8天和21天的血糖峰值均较1天和同期对照组值显著升高。结论:对于低体重危重症患者,rhGH联合谷氨酰胺可以显著提高合成代谢,改善正氮平衡,提高机体免疫力,但需加强血糖的监测及调控。

Objective：To observe the effect of recombinant human growth hormone （rhGH） combined glutamlne in treatment on the light weight critically ill patients in positive nitrogen balance,blood glucose and humoral immune function.Methods：40 patients met the light weight （BMI〈I 8.5kg/m2） diagnostic criteria for a comprehensive Critical Care Medicine were selected and randomly divided into control group （n=20） and rhGH group （n=20）.rhGH treatment, days of observation after treatment of human 8,21 urea nitrogen,blood glucose and humoral immune IgA,IgG,IgM levels were observed.The rhGH group was treated with subcutaneous rhGH （Saizen, Merck Serono） 10IU,once a day for 7 days to once every other day for 2 weeks based on nutritional support.The control group given the same treatment of nutritional support program. The two groups were observed human blood urea nitrogen,blood glucose and humoral immune IgA,lgG,IgM levels before treatment,8,21-day after treatment.Results：8d and 2 ld after rhGH treatment,BUN values of the rhGH group were significantly lower than control group, in which rhGH group compared with 21-day BUN values decreased significantly on 8-day;the two groups showed no difference in the first 7 days after the treatment and the 8-day to 2 l-day of the rhGH group of albumin infusion was significantly lower than the control group;in the 21-day, IgA,IgG of the rhGH group were significantly increased than 1-day,8-day and the control group,IgM between the two groups in before and after treatment was no significant difference;after injection of rhGH,blood glucose peak level in 8-d and 21-d was significantly increased then ld and the same period of the control group.Conclusion：For light weight critically ill patients,rhGH combined glutamine can significantly improve the constructive metabolism,improving the positive nitrogen balance,improve immunity, but need to strengthen the monitoring and regulation of blood glucose.