摘要：目的研究添加生长激素(rhGH)及谷氨酰胺(Gln)的肠外营养(PN)，对短肠大鼠残存小肠代偿的作用及作用机制。方法将SD大鼠按2×2析因设计方案随机分成STD组(-rhGH，-Gln)、rhGH组(+rhGH，-Gln)、Gln组(-rhGH，+Gln)及GG组(+rhGH，+Gln)共四组，建立PN短肠大鼠动物模型，行PN6天。PN结束后行小肠粘膜形态学定量检查，以免疫组化及TUNEL法行小肠粘膜上皮细胞PCNA表达及凋亡小体测定，RT-PCR法行凋亡相关基因bcl-2与baxmRNA表达测定，Northernblot法行小肠粘膜IGF-ImRNA表达测定。结果GG组残余小肠粘膜形态学上呈显著代偿表现，其PCNA表达明显增高，凋亡指数下降；凋亡相关基因bcl-2mR-NA表达升高，baxmRNA表达下降，P＜0．01。析因分析表明rhGH与Gln间存在协同作用。小肠局部IGF-ImRNA表达在rhGH组及Gln组均增高，在GG组增高最为明显，P＜0．05。结论联用rhGH组与Gln，显著促进PN时短肠大鼠残余小肠代偿，二者间作用存在协同肠粘膜上皮细胞增生增加及凋亡抑制与小肠代偿密切相关；小肠局部IGF-I在rhGH与Gln协同作用的发挥中起重要介导作用。

Simultaneous treatment with rhGH and Gin additively improves intestinal adaptation in parenteral fed, short bowel rats

gU Yan,XIE Jianxin,WU Zhaohan(Surgical Department, Zhongshan Hospital, Shanghai Medical University, Shanghai 200032)

Abstract：Objective To understand the potential synergisite effects of rhGH and Gln on postresectional adaptation of the remnant small intestine in parentera fed, short bowel rats. Methods Four PN treatment groups of SBS rat were randomized arranged in a 2 × 2 factorial design as follows: STD group(-rhGH,-Gln),Gin group (-rhGH, +Gln), rhGH group (+rhGH, -Gln) and GG group (+rhGH, +Gin). The morphological changes of the intestinal mucosal epithelia were determined; The expression of PCNA and the occurrence of the apoptosis were observed by immunohistochemical staining and TUNEL methods. The intestinal mucosal bcl-2 and bax mRNA were determined by RT-PCR methods; Intestinal IGF-1 mRNA were determined by Northern blot assays. Results Mucosal thickness, villous height, crypt depth and villous surface of the remnant small intestine in GG group were increased significantly compared to other 3 groups; The expression of PCNA was increased but the rate of apoptosis was decreased significantly; The expression of bcl-2 mRNA was increased accordingly, and bax mRNA was just on the contrary, P＜0.01. There are synergistic effects between rhGH and Gin statiticaUy. The expression of the intestinal IGF-1 mRNA was higher in rhGH and Gin groups than STE) group, and was highest in GG group, P＜0.05. Conelasions The combination of rhGH and Gin can significantly improve the adaptation of the remnant small intestine in parenterally fed, SBS rats, there are synergistic effects between them; The increase of proliferation and the decrease of apoptosis in the remnant intestinal epithelial cells are involved in this process; The intestinal iGF-I p; ays an important role in the intestinal adaptation. Our findings support the concept that specific gut-trophic nutrients and growth factors may combined to enhance the intestinal adaptation and reduce the severity of short bowel syndrome.