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[The effect of enteral nutritional support and growth hormone on critical patients].
Zhou, RX, Weng, FZ, Yan, J, Fan, XP
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue. 2010;(1):40-3
Abstract
OBJECTIVE To explore the effect of early enteral nutritional support and growth hormone (GH) on critical patients. METHODS Sixty-eight critical patients were divided into enteral nutrition (EN) group and EN+GH group, with 34 patients in each group, by random number table. All the patients in both group received early enteral nutritional support, at the same time, the patients in EN+GH group received GH 5 U, once a day for 10 days. The intake was isonitrogenous and isocaloric in both groups. Body weight, blood biochemistry examination, nutrition state and lactulose/mannitol test were performed before and 5 days and 10 days after nutritional support. Immune function was performed after 10 days. Nitrogen balance was measured daily. RESULTS The changes in body weight, albumin and transferring levels were more obvious in the EN+GH group than those in the EN group before and 5 days and 10 days after nutritional support, but the difference was not significant between the two groups. On the 5th and 10th day after treatment, the level of prealbumin [the 5th day:(25.34+/-4.26) g/L vs. (20.62+/-3.58) g/L; the 10th day: (27.34+/-4.25) g/L vs. (23.87+/-2.96) g/L] and that of fibronectin [the 5th day: (2.68+/-0.37) mg/L vs. (2.01+/-0.27) mg/L; the 10th day: (2.74+/-0.31) mg/L vs. (2.44+/-0.19) mg/L] in the EN+GH group were significantly higher than those in the EN group (all P<0.05). However, the level of lactulose/mannitol was significantly lower in EN+GH group than that in the EN group (the 5th day: 0.065+/-0.004 vs. 0.087+/-0.005, the 10th day: 0.027+/-0.002 vs. 0.053+/-0.004, both P<0.01). On the 10th day after treatment, the level of IgA in the EN+GH group was significantly lower than that in the EN group [(2.10+/-0.09) g/L vs.(3.45+/-0.25) g/L], but the levels of CD3 (0.682+/-0.049 vs. 0.606+/-0.046), CD4 (0.456+/-0.039 vs. 0.372+/-0.032), CD4/CD8 ratio (1.66+/-0.11 vs. 1.41+/-0.12), and the natural killer cell (NK cell, 0.139+/-0.011 vs.0.107+/-0.004) in the EN+GH group were significantly higher than those in the EN group (all P<0.05). The gut barrier function in the EN+GH group was superior to that in the EN group during nutritional support period. Nitrogen balance was positive in the EN+GH group [(27.54+/-23.15) mg/kg] and negative in the EN group [-(5.13+/-4.26) mg/kg]. CONCLUSION Early enteral nutritional support can improve state of nutrition, and it is combined with GH composition of protein may be improved and the immune function may be enhanced.
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Proteomic profiling of growth hormone-responsive proteins in human peripheral blood leukocytes.
Chung, L, Nelson, AE, Ho, KK, Baxter, RC
The Journal of clinical endocrinology and metabolism. 2009;(8):3038-43
Abstract
CONTEXT GH is a known modulator of the immune system, but the effect of exogenous GH administration on white blood cell proteins has not been investigated. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) is a powerful platform for the study of GH effects on immune system proteins. OBJECTIVE Our objective was to explore a novel approach for the detection of GH-responsive proteins in human leukocytes by proteomic analysis using SELDI-TOF MS. DESIGN We conducted a randomized double-blind, placebo-controlled GH administration study of 8 wk treatment followed by 6 wk washout. Pre- and posttreatment samples from 30 subjects were used for biomarker discovery. SETTING The study was performed at a clinical research facility. PARTICIPANTS We studied 30 recreationally trained healthy athletes. INTERVENTION Subjects received either recombinant human GH (2 mg/d sc; n = 22) or placebo (n = 8) for 8 wk. MAIN OUTCOME MEASURES Proteomic profiles were determined using CM10 weak cation-exchange protein chips, and some GH-regulated proteins were purified and identified by mass spectrometry and/or immunoblotting. RESULTS SELDI-TOF analysis revealed a number of GH-regulated peptides/proteins in the 3- to 22-kDa range that are either up- or down-regulated by GH. Several of these may be useful as biomarkers of GH action. The calcium-binding, proinflammatory calgranulins S100A8, S100A9, and S100A12 were all significantly down-regulated in response to GH treatment. CONCLUSION This study illustrates the novel use of human leukocyte proteomic profiling by SELDI-TOF MS and reveals the negative regulation of proinflammatory S100 proteins by GH in human white blood cells.
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Glutamine and recombinant human growth hormone protect intestinal barrier function following portal hypertension surgery.
Tang, ZF, Ling, YB, Lin, N, Hao, Z, Xu, RY
World journal of gastroenterology. 2007;(15):2223-8
Abstract
AIM: To evaluate the effects of combined treatment of glutamine (Gln) and recombinant human growth hormone(rhGH) on intestinal barrier function following portal hypertension surgery. METHODS This study was designed as a prospective, randomized and controlled clinical trial. Forty two patients after portal hypertension surgery were randomly assigned into 2 groups: control group (n = 20) and supplemental group (adding Gln and rhGH, n = 22). Every patient received isocaloric and isonitrogenous standard total parenteral nutrition (TPN) starting 3 d after surgery for 7 d. Blood samples were obtained before surgery and at the 3rd and 10th day postoperatively. Host immunity was evaluated by measuring levels of CD4, CD8, CD4/CD8, IgG, IgM and IgA, and the inflammatory responses were determined by assessing IL-2, TNF-alpha and C-reactive protein (CRP) levels. Intestinal permeability and integrity was evaluated by L/M test and histological examination, respectively. RESULTS On postoperative d 10, CD4, CD4/CD8, IgG and IL-2 levels in supplemental group were significantly higher than those in control group (33.7 +/- 5.5 vs 31.0 +/- 5.4, P < 0.05, (1.17 +/- 0.32 vs 1.05 +/- 0.15, P < 0.05, 13.94 +/- 1.09 vs 12.33 +/- 1.33, P < 0.05, and 368.12 +/- 59.25 vs 318.12 +/- 45.65, P < 0.05, respectively), whereas the increase in serum TNF-alpha concentration was significantly reduced (41.02 +/- 27.56 vs 160.09 +/- 35.17, P < 0.05). The increase in L/M ratio was significantly lower in the supplemental group than in the control group (0.0166 +/- 0.0017 vs 0.0339 +/- 0.0028, P < 0.05). Moreover, mucosal integrity in the supplemental group was better than in the control group. CONCLUSION Postoperative administration of TPN supplemented with Gln and rhGH in patients after portal hypertension surgery improves immune function, modulates inflammatory response, prevents the intestinal mucous membrane from atrophy and preserves intestinal integrity.
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Longitudinal growth in children following kidney transplantation: from conservative to pharmacological strategies.
Ulinski, T, Cochat, P
Pediatric nephrology (Berlin, Germany). 2006;(7):903-9
Abstract
Impairment of longitudinal growth in children with chronic renal failure (CRF) is multifactorial. It is mainly due to disturbances in the growth hormone (GH)/insulin-like growth factor (IGF)/IGF-binding protein axis. Growth failure can be managed by optimizing nutrition and fluid/electrolyte homeostasis, and overcoming the growth-inhibiting effects of uremia by high-dose recombinant human (rh) GH treatment. A sufficient catch-up growth is one of the determining issues for the overall success of pediatric kidney transplantation (Tx). However, despite satisfactory renal function, spontaneous catch-up growth is often insufficient as glucocorticoid treatment is the main inhibiting factor for longitudinal growth after Tx. In addition, longitudinal growth may be jeopardized by low glomerular filtration rate (GFR) and African American or Hispanic background. Supraphysiological doses of GH and/or IGF-I in vitro and in vivo can partially overcome the growth-inhibiting effects of glucocorticoid treatment. GH-associated increase of leukocyte proliferation and cytotoxicity with stimulated interferon synthesis have been demonstrated. However, it is not clear whether such stimulatory effects on leukocyte function are a transitory or a constant risk factor after organ Tx. Clinical trials of GH in children after renal Tx have suggested a rather moderate or transient effect of rhGH on the immune system, and corticosteroids induce a hyporesponsiveness to the action of GH. As long as corticosteroids are believed to be essential after renal Tx, rhGH should be considered to optimize longitudinal growth in children.
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[Influence of glutamine and growth hormone intensified nutrition support on immunomodulation in critically ill elderly patients].
Cai, GL, Yan, J, Yu, YH, Zhang, ZC, Gong, SJ, Dai, HW, Chen, J
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue. 2006;(10):595-8
Abstract
OBJECTIVE To evaluate the impacts of glutamine (Gln) and recombinant human growth hormone (rhGH) intensified nutrition support on critically ill elderly patients. METHODS Ninety critically ill aged patients were included in a prospective, randomized and controlled clinical study, and randomly divided into three groups: group A (standard nutrition support), group B (standard nutrition support+10% Gln 100 ml/d), group C (standard nutrition support+ Gln 100 ml/d+rhGH 10 U/d). Before treatment and then 7 and 14 days after treatment, blood samples were collected for analysis of serum proteins including albumin (ALB), pre-albumin (PAB), C-reactive protein (CRP), immunoglobulin G (IgG). Meanwhile, the variables including T-cell subsets, CD14 human leukocyte antigen (locus) DR (CD14 HLA-DR), and total lymphocytes were measured. The changes in acute physiology and chronic health evaluation II (APACHE II) and multiple organ dysfunction syndrome (MODS) scores, the durations of intensive care unit (ICU) stay and mechanical ventilation, and 28-day survival rate were recorded. RESULTS Comparing with group A and B, the levels of serum ALB, PAB and IgG were significantly elevated in group C. The T-cell subsets, CD14 HLA-DR and the number of total lymphocytes were markedly higher in group C (P<0.01), and the APACHE II and MODS scores were decreased significantly in group C (P<0.05 or P<0.01). The levels of serum CRP were lowered significantly in group C (P<0.01). There were no significant differences in the durations of ICU stay, mechanical ventilation and 28-day survival rate among three groups (all P>0.05). CONCLUSION Gln and rhGH intensified nutrition support can improve nutritional condition and immune function, downregulate the inflammatory response in the critically ill elderly patients.
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Low-dose growth hormone and human immunodeficiency virus-associated lipodystrophy syndrome: a pilot study.
Andersen, O, Haugaard, SB, Flyvbjerg, A, Andersen, UB, Ørskov, H, Madsbad, S, Nielsen, JO, Iversen, J
European journal of clinical investigation. 2004;(8):561-8
Abstract
BACKGROUND Treatment with high doses (2-6 mg day(-1)) of human growth hormone (hGH) in patients with human immunodeficiency virus (HIV)-associated lipodystrophy syndrome (HALS) has been shown to increase concentrations of total insulin-like growth-factor-I (IGF-I) more than twofold greater than the normal upper range and is accompanied by adverse effects such as joint pain and glucose intolerance. MATERIALS AND METHODS We performed a 16-week open-labelled prospective pilot study in six male HALS patients using a s.c. low-dose hGH, 0.7 mg day(-1), aiming to examine the impact on total and free IGF-I and fat distribution. Glucose metabolism was examined by oral glucose tolerance tests and hyperinsulinaemic euglycaemic clamps. RESULTS Total IGF-I increased twofold (P < 0.01) and free IGF-I increased 2.5-fold (P < 0.01) to the level of the normal upper range. HDL-cholesterol increased (P = 0.01). Patients reported improvements of lipodystrophy, which was supported by a decreased waist-to-thigh ratio (P = 0.01), and waist-to-hip ratio (P = 0.06). Ratio of peripheral to trunk soft tissue mass increased (P = 0.01, measured by dual-energy X-ray absorptiometry scans) and a trend towards reduction in percentage of trunk fat was suggested (P = 0.12). Total fat mass, exercise capacity, glucose tolerance, glucose disposal rate and immune status, respectively, did not change (all P > 0.5). The patients did not complain of arthralgia or other known GH-related side-effects. CONCLUSIONS Sixteen weeks' treatment of lipodystrophic HIV-infected patients with hGH, 0.7 mg day(-1), increased total and free IGF-I twofold and appeared safe and tolerable. The potential of low-dose hGH in the treatment of HIV-lipodystrophy awaits examination by placebo-controlled, randomized trials.
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Impact of perioperative treatment of recombinant human growth hormone on cell immune function and intestinal barrier function: randomized, double-blind, controlled trial.
Liu, W, Jiang, Z, Wang, X, Shu, H, Cui, W, Wilmore, DW
World journal of surgery. 2003;(4):412-5
Abstract
The objective of this study was to evaluate the effects of recombinant human growth hormone (GH) on cell immune function, intestinal barrier function, and outcome. A placebo-controlled randomized double-blind trial was performed, with 20 patients undergoing abdominal surgery enrolled in the study. The patients in the study group received GH (0.3 IU/kg/day) subcutaneously from day 3 before operation until day 7 after operation. The patients in the control group received placebo injections. All the patients were given isonitrogenic (0.15 g N/kg/day) and isocaloric (20 kcal/kg/day) parenteral nutrition from preoperative day 1 through postoperative day (POD) 6. The serum GH and insulin-like growth factor-1 (IGF-1) levels, intestinal permeability, peripheral CD4+/CD8+ lymphocyte subsets, and routine blood and biochemistry analyses were evaluated before and after GH treatment. In the study group a significant increase in serum levels of GH and IGF-1 was observed on PODs 3 and 7. A significant decrease in the CD4+ subset population and the CD4+/CD8+ ratio was observed in the control group on POD 7 compared with preoperative studies, whereas no change was observed in the study group. The lactulose/mannitol excretion (L/M) ratio in the control group was elevated significantly on POD 7 compared with that before operation ( p = 0.01), whereas the L/M ratio in the study group did not change compared to preoperative values ( p = 0.08). No adverse reactions were related to the administration. There were no differences observed in operation-related complications or postoperative hospital stays between the two groups. This small pilot study suggests that GH attenuated the depression in cellular immunity following surgical stress and possibly reduced the increase in intestinal permeability that occurs following operation. Further studies of a large group of patients are needed to determine if these changes can be translated into improved outcome in surgical patients.