| ObjectiveSevere burn, trauma, shock, infection and other pathological factors can all lead to intestinal barrier dysfunction. It might be suggested that gut derived infection play an important role in the pathogenesis of early sepsis, hypermetabolism, septic shock and MODS. It is deeply in need and very impotant to explore effective methods to preserve normal intestinal mucosal barrier and prevent gut derived infection caused by traumatic stress. Besides accelerating wound healing, improving immune function, decreasing stress response, growth hormone(GH) can also promote postburn intestinal mucosal epithelial proliferation and inhibit injury epithelial apoptosis, thus preserve postburn intestinal mucosal barrier function.The current study was performed to explore the effects of great dose of recombinant human growth hormone(rhGH) presenting in early postburn stage in maintaining intestinal mucosal permeability, endotoxin translocation and intestinal mucosal ultrastructure. Subsequently, clinical trial based on the experiments on animals was performed to observe the protective effects on intestinal mucosal barrier function in severe burned patients. Methods30 grown male Wistar rats were randomly divided into three groups, control, scalding and GH groups.The rats in scalding and GH groups were inflicted with 25% TBSA III degree scalding on the back .The scalded rats were administered with normal saline and GH(1.33U/kg/d) since 2 postburn hours (PBHs), respectively in the last two group.The changes of blood level of diamine oxidase (DAO), D-lacticacid and endotoxin were observed on 24 and 96 PBHs. The changes of epithelial and cell junction ultrastructure, the intestinal mucosal pathomorphology of distal end of ileal mucosal tissue were also observed on 24 and 96 PBHs. According to the results of those experiments on animals, 40 severe burn patients were randomly divided into test(T) and control(C) groups with 20 patients in each group.Patients in T group were given rhGH 0.3IU/Kg/d for 7 days since 48 PBHs,while those in C group received placebo. Blood levels of DAO activity, endotoxin and urine lactulose/mannitol (L/M) test were monitored before and after the administration of the agents,while the change in blood and urine routine and hepatic and renal functional indices were also observed.Results1.The DAO acivity, D-lacticacid and endotoxin levels in plasma were evidently higher in scalding group than in control group and GH group (P<0.01～0.05) on 24 and 96 PBHs. The datas were also higher in GH group than in control group on 24 PBHs (P<0.01～0.05), and decreased on 96 PBHs. The endotoxin levels had no significant difference with contral group (P>0.05) on 96 PBHs. The intestinal mucosal morphology,epithelia and its cell junction in scalding group were severely injured but were significantly a meliorated by rhGH to near those in control group on 24 and 96 PBHs.2. There was no difference of the general data and the hepatic and renal functional indices between the two groups.The DAO activity, endotoxin levels and intestinal mucosal permeability (L/M) before administration were evidently higher than those after it (P<0.01) in T group,and the data in C group were evidently higher than those in T group (P<0.01) after administration.ConclusionsrhGH presented in early postburn stage can effectively lessen intestinal mucosal permeability, reduce the intestinal bacteria/endotoxin translocation .decrease the damage of organs and maintain the normal morphological structure of intestinal mucosa in severe burned rats. rhGH can also abate the degree of intestinal mucosal injury, reduce the intestinal bacteria/endotoxin translocation and protect intestinal mucosal barrier function in severe burned patients.
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