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目的探讨肝细胞癌合并肝硬化病人术后的营养支持。方法24例行根治性切除的肝癌病人随机分为PN组(n=12)和rhGH+PN组(n=12)。术前、术后1 d和术后6 d测肝功能、血糖、AFP、血清前白蛋白、转铁蛋白及血清GHI、GF-1I、GFBP-3,用RT-PCR法检测肝组织(包括癌组织,癌旁组织和术后6 d肝穿刺组织)ALBmRNAI、GF-1mRNA、IGFBP-3mRNA的表达,肝组织行Ki67免疫组织化染色。同时选12例因胆石症或肝血管瘤行手术的病人作为正常对照。结果肝细胞癌合并肝硬化病人血清前白蛋白,转铁蛋白低于正常对照组,血清GH水平高于正常对照组,而血清IGF-1I、GFBP-3水平低于正常对照组;术后6 d,rhGH+PN组血糖、血清前白蛋白、转铁蛋白、血清GHI、GF-1I、GFBP-3水平、肝ALBmRNAI、GF-1mRNAI、GFBP-3mRNA表达水平、肝Ki67指数均高于PN组。血清GH水平与血糖呈正相关,血清IGF-1I、GFBP-3水平与血清AST、ALT、TBIL呈负相关,与血清ALB、前白蛋白,转铁蛋白呈正相关。结论rhGH+PN有利于肝细胞癌合并肝硬化病人术后生长激素/胰岛素样生长因子-1轴的恢复,检测血清IGF-1、IGFBP-3水平有助于了解短期营养支持的效果和选择营养素。
Objective To investigate the nutritional support of hepatocellular carcinoma patients with cirrhosis after operation. Methods Twenty-four patients with radical resected liver cancer were randomly divided into PN group (n = 12) and rhGH + PN group (n = 12). Liver function, blood glucose, AFP, prealbumin, transferrin and serum GHI, GF-1I and GFBP-3 were measured before operation, 1 d after operation and 6 d after operation. The expression of ALBmRNAI, GF-1mRNA and IGFBP-3mRNA were detected by immunohistochemical staining of Ki67 in liver tissue, adjacent tissue and 6-day postoperative liver biopsy. At the same time selected 12 cases of patients with cholelithiasis or hepatic hemangioma surgery as a normal control. Results Serum prealbumin and transferrin in patients with hepatocellular carcinoma complicated with cirrhosis were lower than those in the normal control group, serum GH levels were higher than those in the normal control group, while serum IGF-1I and GFBP-3 levels were lower than those in the normal control group. d. The levels of blood glucose, prealbumin, transferrin, serum GHI, GF-1I, GFBP-3, liver ALBmRNAI, GF-1mRNAI, GFBP-3mRNA and liver Ki67 index in rhGH + PN group were higher than those in PN group . Serum GH levels were positively correlated with blood glucose. Serum IGF-1I and GFBP-3 levels were negatively correlated with serum AST, ALT, TBIL and positively correlated with serum ALB, prealbumin and transferrin. Conclusions rhGH + PN is beneficial to the recovery of postoperative growth hormone / insulin-like growth factor-1 axis in patients with hepatocellular carcinoma and cirrhosis. Detecting the serum levels of IGF-1 and IGFBP-3 may help to understand the effect of short-term nutritional support and the selection of nutrients .