胃肠肿瘤术后短期应用生长激素对患者营养状况及预后的影响

Effect of short-term adiministration of growth hormone on serum IGF-1 and nutritional status in patients after gatrointestinal surgery

目的探讨生长激素短期使用对胃肠肿瘤患者术后营养状况的影响。方法选择我院2007年5月~2009年12月住院接受手术治疗的61例胃肠肿瘤患者作为研究对象,随机分为实验组29例和对照组32例,两组术后均给予抗生素和营养支持治疗。实验组在上述基础上第3天起每日注射重组人生长激素0.15 U/kg,对照组给予安慰剂连续7 d。术后第3~9天测定氮平衡,同时于术前1 d及术后10 d测定血清白蛋白、纤维连接蛋白、及血清胰岛素样生长因-1（IGF-1）水平。术后2年进行随访,并记录肿瘤复发转移情况。结果实验组术后累积氮平衡为（12.05±11.32）g,对照组为（-7.78±12.24）g,两组比较差异有高度统计学意义（P〈0.01）;术后第10天实验组IGF-1和纤维连接蛋白明显高于对照组（P〈0.05）,而血浆蛋白差别无统计学意义（P=0.53〉0.05）。术后随访24个月,对照组肿瘤复发或转移6例（25.0%）,实验组7例（21.9%）,随访期间,实验组与对照组转移复发风险无差别（HR=0.75,95%CI：0.25～2.23,P=0.60〉0.05）。结论短期小剂量生长激素联合早期营养支持,可以促进胃肠外科术后患者氮平衡,且不增加肿瘤的复发和转移风险。

Objective To evaluate the effect of the short-term administration of growth hormone on serium insulin-like growth factor-1（IGF-1） level and nutritional status in patients after gastrointestinal operation.Methods 61 patients undergoing major gastrointestinal operation were random divided in to two groups from May 2007 to Deccember 2009.One was experimental group with 29 patients and the other was control grup with 32 patients.The two groups received the same isocaloric isonitrogenous nutrition with daily injection of either GH 0.15 or placebo for a period of day 3~9 postoperatively.Serum albumin,fibronectin and IGF-1 were tested before and 10 days after operation by using standard laboratory techniques.Nitrogen balance was measured daily from day 3 to 9 after operation.Adverse reaction were observed,all cancer patients received regular abdominal B type ultrasonography and chest X-ray examination dring the following 2 years.Results Compared to control group,the cumulatiev nitrogen balance in experimental group was much higher than that of control group [（12.05±11.32） g vs（-7.78±12.24）g,P 0.01];10 days after operation,the IGF-1and serum fibronectin level of experimental group was hihger than that of control group（P 0.05）.But no statistical difference of serium albumin was observed between two group after operation（P = 0.53 0.05）.In the 24 month follow-up period,6 and 7 pateints suffered from recured or metastasis disease in control group and experimental group respectively（HR = 0.75,P = 0.60 0.05）.Conclusion Short-term administration on using low-dose GH combined with early nutrition support can improve the total nitrogen retention,but not increase the risk of tumor recurrence or metastases.