Exogenous growth hormone: effects on the catabolic response to surgically produced acute stress and on postoperative immune function.
The first purpose of the present prospective randomized study was to determine if the protein catabolic response after operation could be restrained by administration of hypocaloric parenteral nutrition (HPN) plus human growth hormone (hGH). Our second aim was to determine if the administration of hGH could improve the systemic host defenses, thereby reducing the risk of infection. We performed a placebo-controlled randomized double-blind trial in 180 patients after elective cholecystectomy with or without choledochoduodenostomy (placebo = control group, n = 93; hGH-treated group, n = 87). The results obtained in this study show that positive nitrogen balance can be achieved during the postoperative period from the first 24 hours onward, with a combination of HPN support (1.0-1.5 g protein/kg/day and 900 kcal/day) together with the administration of small doses (8 IU) of hGH. The potassium balance tended to follow the same positive balance as the nitrogen balance. Our study shows that in the control group, treated only with HPN, a significant decrease in serum levels of some acute-phase proteins (retinol-binding protein, transferrin, prealbumin), albumin, total proteins, and immunoglobulins occurs by the 5th postoperative day. In the GH group the values of all the above-mentioned proteins do not change or tend to rise if compared to preoperative levels. In the GH-treated group liver function appeared to improve at the start of the study. GH and somatomedin C levels were similar in the two groups and had not changed significantly in the control group by the 5th postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)
Vara-Thorbeck
R
R
Department of Surgery, University of Granada, Spain.
Guerrero
J A
JA
Rosell
J
J
Ruiz-Requena
E
E
Capitán
J M
JM
D001798:Blood Proteins / Q000378:metabolism; D002763:Cholecystectomy / Q000009:adverse effects*; D002768:Choledochostomy / Q000009:adverse effects; D004311:Double-Blind Method; D013006:Growth Hormone / Q000494:pharmacology*; D006801:Humans; D007121:Immunocompetence; D008099:Liver / Q000503:physiopathology; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D011506:Proteins / Q000378:metabolism; D013312:Stress, Physiological / Q000097:blood / Q000209:etiology / Q000276:immunology / Q000503:physiopathology*
D001798:Blood Proteins; D011506:Proteins; D013006:Growth Hormone