Altered plasma cytokines and total glutathione levels in parenterally fed critically ill trauma patients with adjuvant recombinant human growth hormone (rhGH) therapy
Altered plasma cytokines and total glutathione levels in parenterally fed critically ill trauma patients with adjuvant recombinant human growth hormone (rhGH) therapy
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DOI：
10.1097/00003246-200002000-00006
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发表时间：
2000-02-01
影响因子：
8.8
通讯作者：
Petersen, SR
中科院分区：
文献类型：
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作者：
Jeevanandam, M;Begay, CK;Petersen, SR
目的：谷胱甘肽（GSH）是一种强有力的内源性抗氧化剂，是机体对抗氧代谢的重要防御机制之一。GSH的血浆水平主要通过肝脏分泌和肾脏降解之间的平衡来维持。维持和增强组织GSH的能力在响应于刺激如损伤而控制细胞因子产生中可能是特别重要的。严重创伤后GSH与细胞因子、肿瘤坏死因子（TNF）-α和白细胞介素（IL）-6之间的相互作用，该研究的目的是调查在我们的I级创伤中心的重症监护室接受重组人生长激素（rhGH）治疗的成人患者的血浆GSH和细胞因子TNF-α和IL-6的水平。设计：前瞻性、随机、对照试验。设置：创伤重症监护室。患者：28例多发性损伤患者和14例正常吸收后对照。干预：从伤后48-60小时，当复苏完成时，达到稳定的血液动力学状态，并且患者接受不含氮或卡路里的维持液，抽取血液样品用于基础、血浆GSH、TNF-α和IL-6测量。然后开始静脉喂养并持续7天。患者随机接受或不接受重组人生长激素（0.15 mg rhGH/kg/d）每日肌内给药。每天早晨血浆中获得的GSH，TNF-α，IL-6 levels.Results的分析：在早期分解代谢的“流相”的严重损伤，血浆中的GSH水平没有改变，但血浆TNF-α和IL-6水平显着增加，与未受伤的控制。7天的全胃肠外营养单独提高血浆GSH水平（76%），但没有观察到TNF-α的变化。补充rhGH可提高GSH（180%）和TNF（65%），而IL-6水平无变化。有一个显着的线性关系，血浆GSH和TNF-α水平在我们的rhGH补充trauma patients.Conclusion：修改血浆GSH和TNF-α水平的足够的营养支持与佐剂rhGH在伤后期间表现出有益的作用，GSH在增强抗氧化防御。
Objectives: Glutathione (GSH) is a potent endogenous antioxidant that serves as one of the body's most important defenses against oxygen metabolites. Plasma levels of GSH are maintained primarily by a balance between secretion from the liver and degradation in the kidney. The ability to maintain and enhance tissue GSH may be of particular importance in controlling cytokine production in response to a stimulus like injury. The interaction after severe trauma between GSH and cytokines, tumor necrosis factor (TNF) -alpha, and interleukin (IL)-6, are not known.The purpose of the study was to investigate the levels of plasma GSH and cytokines TNF-alpha and IL-6 in adult patients admitted to the intensive care unit of our level I trauma center who were treated with recombinant human growth hormone (rhGH) for greater than or equal to 7 days.Design: Prospective, randomized, controlled trial.Setting: Trauma intensive care unit.Patients: Twenty-eight patients with multiple injuries and 14 normal postabsorptive controls.Interventions: From 48-60 hrs after injury, when resuscitation was complete, a stable hemodynamic status was achieved and the patients were receiving maintenance fluid without nitrogen or calories, a blood sample was drawn for basal, plasma GSH, TNF-alpha, and IL-6 measurement. Intravenous feeding was then started and continued for 7 days. The patients were randomized to receive or not to receive daily intramuscular doses of recombinant human growth hormone (0.15 mg rhGH/kg/day). Daily morning plasma was obtained for analysis of GSH, TNF-alpha, and IL-6 levels.Results: In the early catabolic "flow phase" of severe injury, the plasma levels of GSH were not altered but plasma TNF-alpha and IL-6 levels were increased significantly, compared with uninjured controls. Seven days of total parenteral nutrition alone enhanced plasma GSH levels (76%), hut no change in TNF-alpha was observed. Supplementation with rhGH enhanced GSH (180%), and TNF (65%) with no changes in IL-6 levels. There is a significant linear relationship between plasma GSH and TNF-alpha levels in our rhGH-supplemented trauma patients.Conclusion: Modification of plasma GSH and TNF-alpha levels by adequate nutritional support with adjuvant rhGH during the postinjury period demonstrates the beneficial role of GSH in enhancing antioxidant defenses.