CAJ | 학술논문

目的观察围手术期应用重组人生长激素(rHGH)对肠外营养病人肠粘膜通透性、小肠粘膜形态、细胞免疫功能和预后的影响。方法前瞻性、随机、双盲、安慰剂对照的临床研究。20例因胃肠道疾病行手术治疗的病人进入本研究。术前3天至术后第7天，研究组病人接受rHGH(0.3IU.kg-1.d-1，皮下注射)治疗，对照组接受安慰剂。从术前1天至术后第6天，两组病人接受等氮等热卡的肠外营养(20Kcal.kg-1.d-1,N0.15g.kg-1.d-1)。观察指标包括：肠粘膜通透性、小肠粘膜形态、外周血淋巴细胞亚群和预后。结果(1)rHGH治疗显著提高了研究组病人血浆GH和IGF-1浓度(P=0.0093～0.029),而对照组血浆GH和IGF-1浓度较术前无变化(P=0.25～0.69)。(2)手术后对照组肠粘膜通透性较术前明显升高(P=0.01)，研究组升高不明显(P=0.08)。研究组小肠粘膜厚度和绒毛高度与对照组比较无显著差别(P=0.54,P=0.66)。(3)对照组病人术后CD4+淋巴细胞比例及CD4+/CD8+淋巴细胞比值较术前下降(P=0.03)，研究组术后无明显变化(P=0.09～0.49)，两组间变化差值比较有显著性差异(P=0.02)。(4)临床未见与rHGH治疗有关的严重不反应。rHGH治疗后研究组空腹血糖较治疗前有升高趋势，但与对照组比较无显著差异。(5)两组病人术后并发症及住院时间无显著性差异。结论(1)rHGH减轻手术应激和肠外营养引起的肠粘膜通透性增高，保护肠屏障功能。(2)rHGH治疗防止手术应激引起的细胞免疫功能抑制，保护机体免疫功能。
목적관찰위수술기응용중조인생장격소(rHGH)대장외영양병인장점막통투성、소장점막형태、세포면역공능화예후적영향。방법전첨성、수궤、쌍맹、안위제대조적림상연구。20례인위장도질병행수술치료적병인진입본연구。술전3천지술후제7천，연구조병인접수rHGH(0.3IU.kg-1.d-1，피하주사)치료，대조조접수안위제。종술전1천지술후제6천，량조병인접수등담등열잡적장외영양(20Kcal.kg-1.d-1,N0.15g.kg-1.d-1)。관찰지표포괄：장점막통투성、소장점막형태、외주혈림파세포아군화예후。결과(1)rHGH치료현저제고료연구조병인혈장GH화IGF-1농도(P=0.0093～0.029),이대조조혈장GH화IGF-1농도교술전무변화(P=0.25～0.69)。(2)수술후대조조장점막통투성교술전명현승고(P=0.01)，연구조승고불명현(P=0.08)。연구조소장점막후도화융모고도여대조조비교무현저차별(P=0.54,P=0.66)。(3)대조조병인술후CD4+림파세포비례급CD4+/CD8+림파세포비치교술전하강(P=0.03)，연구조술후무명현변화(P=0.09～0.49)，량조간변화차치비교유현저성차이(P=0.02)。(4)림상미견여rHGH치료유관적엄중불반응。rHGH치료후연구조공복혈당교치료전유승고추세，단여대조조비교무현저차이。(5)량조병인술후병발증급주원시간무현저성차이。결론(1)rHGH감경수술응격화장외영양인기적장점막통투성증고，보호장병장공능。(2)rHGH치료방지수술응격인기적세포면역공능억제，보호궤체면역공능。
Objective To evaluate the effects of rHGH on intestinalpermeability, intestinal morphology and cell immune function. Methods A placebo-controlled randomized double-blind trial was performed. 20 patients undergoing abdominal surgery were randomized into two groups. The patients in the study group received rHGH (0.3IU.kg-1.d-1) subcutaneously from the 3rd day before operation onward to the 7th day after operation. The patients in the control group received placebo. All the patients were given isonitrogenic (N 0.15g.kg-1.d-1) and isocaloric (20 Kcal.kg-1.d-1) parenteral nutrition from the 1st preoperative day to the 6th postoperative day. The intestinal permeability, peripheral CD4+/CD8+ lymphocyte proportion, blood routine and biochemiscal analysis were determined before and after rHGH treatment. The jejunum biopsy was performed on the operation day for the determination of the intestinal morphology. Results 1) GH and IGF-1 levels were similar in the two groups and had not changed significantly in the control group by the 7th postoperative day. In the study group a significant increase in serum levels of GH and IGF-1 was observed on 3rd and 7th postoperative day. 2) The intestinal permeability (L/M) in the control group was elevated on POD+7 (P=0.01), whereas the L/M ratio in the study group kept the same as preoperative(P=0.08). No significant difference was observed on the jejunum morphology between the two groups. 3) A significant decrease in CD4+ subset proportion and CD4+/CD8+ ratio was observed in the control group on the 7th postoperative day, whereas no change was observed in study group. 4) No adverse reaction related with rHGH was observed. Glucose level in the control group was unaltered, but in the study group a trend of rising in glucose level was observed, which was not significant. 5) There was no significant difference in operation-related complication and period of hospital stay between the two groups. Conclusions 1) rHGH prevented the increase of intestinal permeability, preserved intestinal barrier function. 2) rHGH eliminated the depression in cellular immunity following the surgical stress.