手术前应用重组人生长激素对成年手术病人骨骼肌结构和功能的影响

Effects of pre-treatment with recombinant human growth hormone (rhGH) on the structure and function of skeletal muscle of adult surgical patients

目的:手术前应用重组人生长激素(rhGH)对成年手术病人氮平衡、骨骼肌组织结构和功能及IGF-1mRNA基因表达的影响进行临床研究.方法:采用随机、双盲、安慰剂对照的方法.对20例外科病人于手术前3d开始进行GH的合成治疗.结果:病理学检查发现,两组病人腹直肌组织中肌萎缩和肌营养不良的程度和比例无明显差别(P>0.05),Ⅰ型和Ⅱ型肌纤维的分布比例及总RNA的含量也无明显差别(P>0.05);但GH组病人腹直肌组织的胰岛素样生长因子-1信使核糖核酸(IGF-1 mRNA)水平较对照组增高1.6倍(P=0.03);GH组病人术后氮平衡、双手握力、行走速度以及体重等指标明显优于对照组(P<0.05).结论:手术前开始短期应用rhGH的合成治疗,可以调控组织特异性基因的表达,同时保持了外科手术后病人良好的代谢和生理机能状态,可能更有利于术后病人的康复.

AIM: To study the effects of pre-treatment with recombinant human growth hormone (rhGH) on nitrogen balance, IGF-1 mRNA expression the structure and function of skeletal muscle, and IGF-1 mRNA expresion of adult surgery patients. METHODS: We performed the prospective, randomized, double-blind, placebo-controlled study in 20 adult patients with rhGH pre-treatment before surgery. Plasma GH and IGF-1 concentrations, ni-trogen balance, muscle IGF-1 mRNA, muscle function and muscle pathologic examination were measured. RESULTS: After short rhGH administration, there were no significant dif-ferences on muscle morphology and the ratio of type I and type I fiber. Although there was no significant difference on total RNA amount of muscle (P>0. 05), the IGF-1 mRNA was 1. 6 fold increased (P = 0. 03). There were better nitrogen balance, muscle function in rhGH patients than in control. CONCLUSION ? The GH-IGF plays a major role in control-ling the growth and differentiation of skeletal muscles. The positive effects on nitrogen bal-ance, muscle function and IGF-I mRNA expression were found beacause of GH pretreat-ment. The result may be good for the recovery of physiological function in surgical patients.