ANABOLIC THERAPY WITH GROWTH-HORMONE ACCELERATES PROTEIN GAIN IN SURGICAL PATIENTS REQUIRING NUTRITIONAL REHABILITATION
ANABOLIC THERAPY WITH GROWTH-HORMONE ACCELERATES PROTEIN GAIN IN SURGICAL PATIENTS REQUIRING NUTRITIONAL REHABILITATION
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DOI：
10.1097/00000658-199310000-00002
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发表时间：
1993-10-01
影响因子：
9
通讯作者：
WILMORE, DW
中科院分区：
文献类型：
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作者：
BYRNE, TA;MORRISSEY, TB;WILMORE, DW
目的研究外源性生长激素(GH)对接受标准高热量营养治疗的稳定、营养不良的术后患者的蛋白质合成和体重增加的影响。摘要背景资料身体蛋白质的显著丢失损害正常生理功能，并与术后并发症增加和住院时间延长有关。以前的研究表明，标准的营养支持方法可以促进脂肪和细胞外水分的沉积，但不能有效地补充体内蛋白质。方法14名需要长期营养支持的严重胃肠功能障碍患者接受了标准营养治疗(STD)，在最初的7天平衡期内，每天提供大约50大卡/公斤和2g/kg/天的蛋白质。然后患者继续接受STD治疗(n=4)，或同时接受生长激素0.14 mg/kg/d治疗(n=10)。在平衡期第7天和治疗3周后再次测定体重成分，包括体脂、矿物质含量、瘦肉(非脂肪和非矿物质组织)质量、总体水、细胞外水(ECW)和体蛋白。每日和累积的营养平衡和底物氧化研究决定了蛋白质热量的分配、效率和利用。结果GH组患者体脂增加最少，但瘦体重(4.311±-0.6 kg比1.988+/-0.2 kg，p小于等于0.03)和蛋白质(1.417±0.3 kg比0.086±0.1 kg，p小于或等于0.03)显著增加。瘦体重的增加与ECW的不适当扩张无关。相比之下，接受性病治疗的患者倾向于在体重中沉积更大比例的ECW，并比接受GH治疗的患者显著更多的脂肪(1.004+/-0.3千克对0.129+/-0.2千克，p<；0.05)。给予GH改变了底物氧化(呼吸商=0.94+/-0.02GH比1.17+/-0.05STD，p小于或等于0.0002)和有效能量的使用，导致蛋白质沉积效率提高66%(13.37+/-0.8g/1000kcal比8.04g/1000kcal+/-3.06g/1000kcal，P小于或等于0.04)。结论在接受积极营养治疗的稳定成人患者中，GH促进了蛋白质的增加，而体脂没有明显增加，ECW也没有不成比例的扩大。生长激素治疗加速了营养补充，因此可能会缩短需要进行大手术的营养不良患者的康复时间。
Objective The authors investigated the effects of exogenous growth hormone (GH) on protein accretion and the composition of weight gain in a group of stable, nutritionally compromised postoperative patients receiving standard hypercaloric nutritional therapy.Summary Background Data A significant loss of body protein impairs normal physiologic functions and is associated with increased postoperative complications and prolonged hospitalization. Previous studies have demonstrated that standard methods of nutritional support enhance the deposition of fat and extracellular water but are ineffective in repleting body protein.Methods Fourteen patients requiring long-term nutritional support for severe gastrointestinal dysfunction received standard nutritional therapy (STD) providing approximately 50 kcal/kg/day and 2 g of protein/kg/day during an initial 7-day equilibrium period. The patients then continued on STD (n = 4) or, in addition, received GH 0.14 mg/kg/day (n = 10). On day 7 of the equilibrium period and again after 3 weeks of treatment, the components of body weight were determined; these included body fat, mineral content, lean (nonfat and nonmineral-containing tissue) mass, total body water, extracellular water (ECW), and body protein. Daily and cumulative nutrient balance and substrate oxidation studies determined the distribution, efficiency, and utilization of calories for protein. fat, and carbohydrate deposition.Results The GH-treated patients gained minimal body fat but had significantly more lean mass (4.311 +/- 0.6 kg vs. 1.988 +/- 0.2 kg, p less-than-or-equal-to 0.03) and more protein (1.417 +/- 0.3 kg vs. 0.086 +/- 0.1 kg, p less-than-or-equal-to 0.03) than did the STD-treated patients. The increase in lean mass was not associated with an inappropriate expansion of ECW. In contrast, patients receiving STD therapy tended to deposit a greater proportion of body weight as ECW and significantly more fat than did GH-treated patients (1.004 +/- 0.3 kg vs. 0.129 +/- 0.2 kg, p < 0.05). GH administration altered substrate oxidation (respiratory quotient = 0.94 +/- 0.02 GH vs. 1.17 +/- 0.05 STD, p less-than-or-equal-to 0.0002) and the use of available energy, resulting in a 66% increase in the efficiency of protein deposition (13.37 +/- 0.8 g/1000 kcal vs. 8.04 g +/- 3.06 g/1000 kcal, p less-than-or-equal-to 0.04).Conclusions GH administration accelerated protein gain in stable adult patients receiving aggressive nutritional therapy without a significant increase in body fat or a disproportionate expansion of ECW. GH therapy accelerated nutritional repletion and, therefore, may shorten the convalescence of the malnourished patient requiring a major surgical procedure.