重组人生长激素对感染后蛋白质代谢影响的实验与临床研究

Experimental and clinical studies of recombinant human growth hormone on protein metabolism during sepsis

目的 :观察重组人生长激素 (rh GH)对腹腔感染后机体内蛋白质代谢的影响。 方法 :分动物实验和临床实验两部分。动物实验采用盲肠结扎加穿孔以建立腹腔感染模型 ,经颈静脉切开插管建立肠外营养模型。实验动物分为正常组、感染组、rh GH组三组。临床实验选择住院的肠瘘伴腹腔感染患者 30例 ,并随机分为对照组 15例和rh GH组 15例。临床观察 rh GH对患者肝内白蛋白和骨骼肌蛋白质合成的影响 ,且采用逆转录 -多聚酶链反应 (RT-PCR)法测定肝内白蛋白 m RNA和肌纤重链蛋白 (MHC-1) m RNA的表达变化。 结果 :腹腔感染大鼠在应用 rh GH后能明显促进正氮平衡和体重的恢复 ,提高血浆白蛋白与骨骼肌蛋白含量。感染后动物肝内白蛋白 m RNA、骨骼肌肌纤重链蛋白 m RNA表达明显下降 ,应用 rh GH后二者表达显著增强 ,促进了血浆白蛋白和肌蛋白的合成。感染患者应用 rh GH后 ,与对照组相比第 7天时显著提高了血浆白蛋白及转铁蛋白、前白蛋白的浓度 (P<0 .0 1)。 结论 :rh GH能显著促进感染后机体血浆蛋白和骨骼肌蛋白合成。与常规 TPN相比 ,rh GH能进一步提高营养支持的利用效率 ,有望成为临床代谢调理措施的一部分。

Objectives:The present study was undertaken to investigate the effects of recombinant growth hormone(rhGH) on protein metabolism during intraabdominal infection. Methods : The study was made up of two parts: animal experiments and clinical studies. All animals were divided into three groups: normal control, sepsis control and rhGH therapy groups. All patients were divided into two groups: infection control and rhGH therapy groups. Expressions of hepatic albumin mRNA and muscle myosin heavy chain mRNA were detected. Results: In septic animals, rhGH accelerated nitrogen retention and recovery of body weight, improved concentrations of plasma albumin and muscle protein. Expressions of hepatic albumin mRNA and myosin heavy chain mRNA decreased significantly after infection. By using rhGH, expression of albumin mRNA and myosin heavy chain mRNA increased obviously. In clinical study, plasma concentrations of albumin, prealbumin and transferrin were higher than infectious controls after rhGH administration. Conclusions: rhGH improved nitrogen balance and protein synthesis of liver and muscle during sepsis .More studies were needed to determine weather rhGH was an effective metabolic intervention method during sepsis.