谷氨酰胺和生长激素对术后病人肌肉代谢的影响
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中国临床营养杂志000137摘 要：目的许多研究表明，给予生长激素和谷氨酰胺能减少手术后肌肉蛋白的分解(术后肌蛋白分解表现在肌蛋白合成减少、谷氨酰胺水平降低和氮丢失增加)。本研究目的是联合使用生长激素和胰岛素样生长因子(IGF-I，一种能解释生长激素部分作用效果的生长因子)及添加生长激素和谷氨酰胺对术后肌肉代谢的影响。 方法选择代谢正常、尚未转移而又行结肠部分切除的结肠恶性肿瘤患者。这些病人术前体重稳定且基础代谢率在正常范围内。术后三天给予等氮(0.15gN·kg-1·24h-1)、等热卡(28kcal·kg-1·24h-1)的TPN。研究期间，三组病人均给予持续的TPN输注。对照组10人；第二组7人，术后皮下注射生长激素(0.15E/kg)，每天二次；第三组9人，给予等量的生长激素(每次0.15E/kg)和IGF-1(40μg·kg-1·24h-1)，每天二次；另外两组，术后三天内均给予含谷氨酰胺(0.28g·kg-1·24h-1)的TPN，其中一组8人添加生长激素(0.3E.kg-1·24h-1)，另一组8人不添加生长激素，后两组每天给16小时的TPN。术前和术后第三天分别取肌活检进行肌肉氨基酸检测并测定核糖体谱，以了解蛋白合成情况。整个研究过程测定尿标本，测定尿氮含量以计算积累氮平衡，估计肾外丢失量为1.5g/d。 结果对照组术后肌肉谷氨酰胺降低22.9%±5.6%，GH组22.6%±6.5%，GH-IGF-I组22.2%±4.5%，研究期间每组均持续给予PN，而GLN组有47.5%±6.3%下降的时候肌肉谷氨酰胺水平保持不变。对照组核糖体和多核糖体浓度降低约30%。GH组和GH-IGF-I组术后蛋白合成减少。然而，这些指标在给予或不给予生长激素的谷氨酰胺组间无差别。术后给予持续PN的组别，获得正值积累氮平衡，对照组为6.8±1.6g，GH组为10.7±1.3g，GH-IGF-1组为9.4±2.8g。谷氨酰胺和GH联合使用比谷氨酰胺单独使用能减少氮的丢失，-5.8±1.4g对-10.6±1.18，后两组没有持续给予PN。 结论本研究中，当术后给予持续PN时，GH和IGF-I的联合使用没有改善反映蛋白分解的指标两组中标志蛋白合成的指标-肌谷氨酰胺和核糖体均减少。当持续给予PN而没有干预的时候，积累氮平衡得以改善并达到正值，预示氮代谢获得有益的影响。这种营养方式可能会比更高剂量的生长激素对机体的影响要大。与单独使用谷氨酰胺相比，谷氨酰胺与生长激素的协同并没有改变术后谷氨酰胺水平。添加谷氨酰胺后，核糖体的减少说明蛋白合成受到抑制。持续的PN和由此而引起的优化的机体氮代谢可能会解释本研究的结果。似乎可以得出：在对创伤的代谢反应中，生长激素的轻微作用可能会变的不明显。
, 百拇医药
Effects of growth factors and glutamine on postoperative muscle metabolism
Erik Vinnars ,Jan Wernerman
(Ingmar wennstrm and folke hammarqvist, st goran and huddinge univesity Hospital, Stockholm, Sweden)
Abstract：Background. Postoperative muscle protein catabolism reflected by diminished muscle protein synthesis, reduced glutamine levels and increased nitrogenlosses has in many studies been shown to be reduced by the addition of growth hormone and by the addition of glutamine. The combination of growth hormone and insulin like growth factor (IGF-I, a growth factor which may explain some of the effects of growth hormone) and the addition of glutamina together with growth hormone has so far not been studied postoperatively on muscle protein metabolism. This was the aim of this study. Patients and methods. Metabolic healthy patients undergoing elective colonic resection because of non-spread colonic malignancy were included in the study. The patients were preoperatively weight stable and their BMI were within the normal range. They were given isocaloric (28 kcal/kg/24h) and isonitrogenous TPN (0.15 gN/kg/24h) during 3 days following operation. In three groups TPN was given as a continuous infusion during the study. One group served as a control group (n = 10), another group was given GH postoperatively (GH; n = 7) twice a day subcutaneously (0.15E/kg/injection) and a third group (GH-IGF-I, n = 9) was given the same amount of GH and IGF-I twice a day (40mikrog/kg/24h). Two other groups were given glutamine-containing TPN (0.28g glutamine/kg/24h) during 3 days postoperatively either with addition of growth hormone (GH-GLN; n =8) at a dose of 0.3E/kg/24h, or without growth hormone (GLN; n = 8). In the latter two groups the patients were given TPN during 16 hours per day. Preoperatively and on the third postoperative day a muscle biopsy was taken for analysis of muscle amino acids and determination of the ribosomal patttern reflecting protein synthesis. Urine was sampled during the whole study and the cumulated nitrogen balance was calculated by measuring the total nitrogen content in urine, estimating the extrarenal losses to be 1.5g per day. Results Postoperatively the muscle glutamine was reduced with 22.9 ± 5.6 96 in the control, in the GH group with 22.6 ± 6.5 % and in the GH-IGF-I group with 22.2 ± 4.5 %, all groups given continuous Pn during the study the muscle glutamine level unaltered while a 47.5 ± 6.3 % decline was seen in the GLN group. The concentrations of polyribosomes and ribosomes decreased in a similar way by about 30 % in the control group, in the GH-group and in the GH-IGF-I group indicating a decrease in protein synthesis postoperatively. However, these parameters were unchanged in the two groups given glutamine either with or without growth hormone. In the groups given continuous nutrition during the postoperative period the cumulated nitrogen balance was positive, 6.8 ± 1.6g in the control group, 10.7 ± 1.3 in the GH group and 9.4 ± 2.8 in the GH-IGF-I group. The combination of GH and glutamine reduced nitrogen-losses compared with glutamine alone, -5.8 ± 1.4g vs - 10.6 ± 1. 1g. The two latter groups were not given PN continuously. Conclusion The combination of GH and IGF-I did not in this study improve the parameters reflecting postoperative protein catabolism when PN was given continuously. In both groups a decrease in muscle glutamine and ribosome paramenters reflecting a decrease in protein synthesis were seen. When TPN was given continuously without interruption the cumulated nitrogen balance was improved and positive indicating a beneficial effect on nitrogen metabolism. This effect of the administration of nutrition may be of larger importance than the effect of growth factors in high doses. When glutamine is added a synergistic effect with growth hormone is seen on postoperative glutamine levels which were unaltered compared with glutamine administration alone. When glutamine is adcled the decrease in ribosome parameters reflecting protein synthesis is prevented. The continnous infusion of nutrients and thereby optimizing the whole body nitrogen metabolism may explain the results in this study. It is also plausible that when the metabolid response to trauma is marginal the effects of the growth factors may not become obvious., 百拇医药
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中国临床营养杂志000137摘 要：目的许多研究表明，给予生长激素和谷氨酰胺能减少手术后肌肉蛋白的分解(术后肌蛋白分解表现在肌蛋白合成减少、谷氨酰胺水平降低和氮丢失增加)。本研究目的是联合使用生长激素和胰岛素样生长因子(IGF-I，一种能解释生长激素部分作用效果的生长因子)及添加生长激素和谷氨酰胺对术后肌肉代谢的影响。 方法选择代谢正常、尚未转移而又行结肠部分切除的结肠恶性肿瘤患者。这些病人术前体重稳定且基础代谢率在正常范围内。术后三天给予等氮(0.15gN·kg-1·24h-1)、等热卡(28kcal·kg-1·24h-1)的TPN。研究期间，三组病人均给予持续的TPN输注。对照组10人；第二组7人，术后皮下注射生长激素(0.15E/kg)，每天二次；第三组9人，给予等量的生长激素(每次0.15E/kg)和IGF-1(40μg·kg-1·24h-1)，每天二次；另外两组，术后三天内均给予含谷氨酰胺(0.28g·kg-1·24h-1)的TPN，其中一组8人添加生长激素(0.3E.kg-1·24h-1)，另一组8人不添加生长激素，后两组每天给16小时的TPN。术前和术后第三天分别取肌活检进行肌肉氨基酸检测并测定核糖体谱，以了解蛋白合成情况。整个研究过程测定尿标本，测定尿氮含量以计算积累氮平衡，估计肾外丢失量为1.5g/d。 结果对照组术后肌肉谷氨酰胺降低22.9%±5.6%，GH组22.6%±6.5%，GH-IGF-I组22.2%±4.5%，研究期间每组均持续给予PN，而GLN组有47.5%±6.3%下降的时候肌肉谷氨酰胺水平保持不变。对照组核糖体和多核糖体浓度降低约30%。GH组和GH-IGF-I组术后蛋白合成减少。然而，这些指标在给予或不给予生长激素的谷氨酰胺组间无差别。术后给予持续PN的组别，获得正值积累氮平衡，对照组为6.8±1.6g，GH组为10.7±1.3g，GH-IGF-1组为9.4±2.8g。谷氨酰胺和GH联合使用比谷氨酰胺单独使用能减少氮的丢失，-5.8±1.4g对-10.6±1.18，后两组没有持续给予PN。 结论本研究中，当术后给予持续PN时，GH和IGF-I的联合使用没有改善反映蛋白分解的指标两组中标志蛋白合成的指标-肌谷氨酰胺和核糖体均减少。当持续给予PN而没有干预的时候，积累氮平衡得以改善并达到正值，预示氮代谢获得有益的影响。这种营养方式可能会比更高剂量的生长激素对机体的影响要大。与单独使用谷氨酰胺相比，谷氨酰胺与生长激素的协同并没有改变术后谷氨酰胺水平。添加谷氨酰胺后，核糖体的减少说明蛋白合成受到抑制。持续的PN和由此而引起的优化的机体氮代谢可能会解释本研究的结果。似乎可以得出：在对创伤的代谢反应中，生长激素的轻微作用可能会变的不明显。
, 百拇医药
Effects of growth factors and glutamine on postoperative muscle metabolism
Erik Vinnars ,Jan Wernerman
(Ingmar wennstrm and folke hammarqvist, st goran and huddinge univesity Hospital, Stockholm, Sweden)
Abstract：Background. Postoperative muscle protein catabolism reflected by diminished muscle protein synthesis, reduced glutamine levels and increased nitrogenlosses has in many studies been shown to be reduced by the addition of growth hormone and by the addition of glutamine. The combination of growth hormone and insulin like growth factor (IGF-I, a growth factor which may explain some of the effects of growth hormone) and the addition of glutamina together with growth hormone has so far not been studied postoperatively on muscle protein metabolism. This was the aim of this study. Patients and methods. Metabolic healthy patients undergoing elective colonic resection because of non-spread colonic malignancy were included in the study. The patients were preoperatively weight stable and their BMI were within the normal range. They were given isocaloric (28 kcal/kg/24h) and isonitrogenous TPN (0.15 gN/kg/24h) during 3 days following operation. In three groups TPN was given as a continuous infusion during the study. One group served as a control group (n = 10), another group was given GH postoperatively (GH; n = 7) twice a day subcutaneously (0.15E/kg/injection) and a third group (GH-IGF-I, n = 9) was given the same amount of GH and IGF-I twice a day (40mikrog/kg/24h). Two other groups were given glutamine-containing TPN (0.28g glutamine/kg/24h) during 3 days postoperatively either with addition of growth hormone (GH-GLN; n =8) at a dose of 0.3E/kg/24h, or without growth hormone (GLN; n = 8). In the latter two groups the patients were given TPN during 16 hours per day. Preoperatively and on the third postoperative day a muscle biopsy was taken for analysis of muscle amino acids and determination of the ribosomal patttern reflecting protein synthesis. Urine was sampled during the whole study and the cumulated nitrogen balance was calculated by measuring the total nitrogen content in urine, estimating the extrarenal losses to be 1.5g per day. Results Postoperatively the muscle glutamine was reduced with 22.9 ± 5.6 96 in the control, in the GH group with 22.6 ± 6.5 % and in the GH-IGF-I group with 22.2 ± 4.5 %, all groups given continuous Pn during the study the muscle glutamine level unaltered while a 47.5 ± 6.3 % decline was seen in the GLN group. The concentrations of polyribosomes and ribosomes decreased in a similar way by about 30 % in the control group, in the GH-group and in the GH-IGF-I group indicating a decrease in protein synthesis postoperatively. However, these parameters were unchanged in the two groups given glutamine either with or without growth hormone. In the groups given continuous nutrition during the postoperative period the cumulated nitrogen balance was positive, 6.8 ± 1.6g in the control group, 10.7 ± 1.3 in the GH group and 9.4 ± 2.8 in the GH-IGF-I group. The combination of GH and glutamine reduced nitrogen-losses compared with glutamine alone, -5.8 ± 1.4g vs - 10.6 ± 1. 1g. The two latter groups were not given PN continuously. Conclusion The combination of GH and IGF-I did not in this study improve the parameters reflecting postoperative protein catabolism when PN was given continuously. In both groups a decrease in muscle glutamine and ribosome paramenters reflecting a decrease in protein synthesis were seen. When TPN was given continuously without interruption the cumulated nitrogen balance was improved and positive indicating a beneficial effect on nitrogen metabolism. This effect of the administration of nutrition may be of larger importance than the effect of growth factors in high doses. When glutamine is added a synergistic effect with growth hormone is seen on postoperative glutamine levels which were unaltered compared with glutamine administration alone. When glutamine is adcled the decrease in ribosome parameters reflecting protein synthesis is prevented. The continnous infusion of nutrients and thereby optimizing the whole body nitrogen metabolism may explain the results in this study. It is also plausible that when the metabolid response to trauma is marginal the effects of the growth factors may not become obvious., 百拇医药