Metabolic effects of adjuvant recombinant human growth hormone in patients with continuing sepsis receiving parenteral nutrition.

摘要

BACKGROUND: Adjuvant growth hormone is advocated for treating the catabolism of prolonged sepsis not corrected by parenteral nutrition alone. METHODS: An open study was performed in which eight patients whose postabsorptive resting energy expenditure was persistently elevated by a mean of 19% as a result of continuing sepsis were randomized to receive 0.03 or 0.06 mg/kg recombinant human growth hormone (rhGH) each evening for 7 days adjuvant to total parenteral nutrition. Plasma concentrations of growth hormone, insulin, insulin-like growth factors 1 and 2 (IGF-1 and -2) and their binding proteins IGFBP-1 and -3 were measured before and after rhGH, and their relationship with rates of whole-body protein turnover was determined in the morning in the postabsorptive state by using L-[1-13C]leucine. RESULTS AND CONCLUSIONS: Before rhGH, the patients were hyperinsulinemic (mean, 44.4 mU/L) but had growth hormone levels within the normal range (< 10 mU/L). After the seventh dose of rhGH, nocturnal growth hormone concentrations rose to a mean of 35.3 +/- 26.1 and 61.3 +/- 21.05 mU/L for the low and higher dose groups, respectively. Morning IGF-1 concentrations showed a small increase during treatment, rising from a mean of 241.3 +/- 99.0 to 301.7 +/- 167.3 ng/mL for the low-dose group and from 214.5 +/- 74.6 to 294.1 +/- 116.9 ng/mL for the higher-dose group. IGF-2 increased slightly by 89 +/- 39 and 75 +/- 49 ng/mL for the low and higher doses, respectively. IGFBP-1 and -3 and insulin did not change. The balance between nitrogen input and urinary urea nitrogen increased after rhGH by a mean of 5.3 g/d with no differences between the two dosage groups (4.74 +/- 1.56 g/d for the higher dose, 5.94 +/- 3.70 g/d for the lower). No significant changes were observed in whole-body protein turnover after a 1-week course of rhGH.