Growth Hormone for Burn Patients: a Systematic Review of Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Yong ¹ , WU Xiaoting ¹ , WEI Maoling ² , ZHUANG Wen ¹ , DA Mingxu ¹ , HE Tao ¹ , ZHANG Mingming ¹ , QIAN Kun ¹ , LUO Ting ¹

1. Department of General Surgery; W est China Hospital; Sichuan University; Chengdu 610041; China2. Chinese Cochrane Center; West China Hospital; China;

Corresponding author：

Keywords：

Growth hormone; Burn; Randomized cont rolled trials; Systematic review; Meta-analysis

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Objective 　To assess the effectiveness and the safety of clinical use of growth hormone (GH) in burn patients.
Method 　Search were applied to the following electronic databases: Chinese Bio-medicine Database (CBM), MEDLINE, EMBASE and Cochrane Library. Language was restricted in Chinese and English. Data were extracted and evaluated by the two reviewers independently of each other. Applied RevMan 4.1 for statistical analyse.
Results 　Nine trials involving 732 patients were included. The combined results showed that GH can shorten wound healing time [weighted mean difference (WMD) = -11.25, 95%CI (-14.84 to -7.66), P lt;0.000 01], donor site healing times [WMD= -1.87, 95%CI (-2.28 to -1.47), P＜0.000 01), and length of hospital stay [WMD= -8.10, 95%CI (-10.40 to -5.79), P＜0.000 01]. There was no statistical significance on resting energy expenditure [WMD= -0.04, 95%CI ( -0.08 to 0.00), P=0.06], mortality [odds ratio (OR) =1.15, 95%CI (0.15 to 8.53), P=0.9], sepsis [OR=1.08, 95%CI (0.50 to 2.34), P=0.8] and ventilatory support required [OR=1.51, 95%CI (0.72 to 3.16), P=0.3]. Nevertheless, the plasma levels of glucose [standardized mean difference (SMD) =0.98, 95%CI (0.54 to1.42), P＜0.000 01] and insulin [SMD=0.86, 95%CI (0.43 to1.30), P=0.000 1] were increased in GH groups.
Conclusions 　GH for burn patients is effective and safe if blood glucose can be controlled well.

Citation： ZHOU Yong,WU Xiaoting,WEI Maoling,ZHUANG Wen,DA Mingxu,HE Tao,ZHANG Mingming,QIAN Kun,LUO Ting. Growth Hormone for Burn Patients: a Systematic Review of Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2004, 04(2): 92-97. doi: Copy

1.	［1］Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary[J] ?Control Clin Trials, 1996; 17 (1): 1-12.
2.	［2］Hart DW, Wolf SE, Chinkes DL, Lal SO, Ramzy PI,Herndon DN. Beta-blockade and growth hormone after burn[J]. Ann Surg, 2002 ;236(4):450-457.
3.	［3］Hart DW, Herndon DN, Klein G, Lee SB, Celis M, Mohan S, Chinkes DL, WolfSE. Attenuation ofposttraumatic muscle catabolism and osteopenia by long? term growth hormone therapy[J]. Ann Surg, 2001 ;233(6) :827-834.
4.	［4］Jeschke MG, Barrow RE, Herndon DN. Recombinant human growth hormone treatment in pediatric burn patients and its role during the hepatic acute phase response [ J ]. Crit Care Med, 2000 ;28 (5): 1578-1584.
5.	［5］Ranirez RJ, Wolf SE, Barrow RE, Herndon DN. Growth hormone treatment in pediatric bums: a safe therapeutic approach[J]. Ann Surg, 1998 ;228(4) :439-448.
6.	［6］Gilpin DA, Barrow RE, Rutan RL, Broemeling L, Herndon DN.Recombinant human growth hormone accelerates wound healing in children with large cutaneous bums [J ]. Ann Surg, 1994;220(1):19-24.
7.	［7］Fleming RY, Rutan RL, Jahoor F, Barrow RE, Wolfe RR,Herndon DN. Effect of recombinant human growth hormone on catabolic hormones and free fatty acids following thermal injury[J]. J Trauma,1992;32(6) :698-703.
8.	［8］Gore DC, Honeycutt D,Jahoor F, Rutan T, Wolfe RR, Herndon DN Effect of exogenous growth hormone on glucose utilization in burn patients[J]. J Surg Res,1991 ;51 (6) :518-523.
9.	［9］Herndon DN, Barrow RE, Kunkel KR, Broemeling L,Rutan RL. Effects of recombinant human growth hormone on donor? site healing in severely burned children[J]. Ann Surg,1990;212(4) :424-431.
10.	［10］Xu H, Huang YS, P YZ, Liu XS, L QZ, Tian XG, Liu XB. Clinical evaluation of the effects of rhGH on the management of severely burned patients [ J ]. Chinese Journal of Burn, 2002; 18 (5) :288-291.
11.	许辉,黄跃生,彭毅志,刘旭盛,罗奇志,田学功,刘晓冰重组人生长激素应用于烧伤治疗的临床评价[J].中华烧伤杂志,2002;18(5):288-291.
12.	［11］Losada F, Garcia-Luna PP, Gomez-Cia T, Garrido M,Pereira JL, Marin F, Astorga R. Effects of human recombinant growth hormone on donor-site healing in burned adults[J]. World J Surg, 2002 ;26(1) :2-8.
13.	［12］Akcay MN, Akcay G, Solak S, Balik AA, Aylu B. The effect of growth hormone on 24 h urinary creatinine levels in burned patients[J]. Burns, 2001 ;27(1) :42-45.
14.	［13］Pelzer M, Hartmann B, Blome-Eberwein S, Raff T, Germann G. Effect of recombinant growth hormone on wound healing in severely burned adults. A placebo controlled, randomized double-blind phase Ⅱ study [ J ]. Chirurg, 2000; 71 (11):1352-1358.
15.	［14］Lal SO, Wolf SE, Hemdon DN. Growth hormone, burns and tissue healing [ J ]. Growth Horm IGF Res, 2000; 10(Suppl B) :S39-43.
16.	［15］Barret JP, Dziewulski P, Jeschke MG, WolfSE, Herndon DN. Effects of recombinant human growth hormone on the development of burn scarring [J]. Plast Reconstr Surg, 1999;104(3) :726-729.
17.	［16］Demling RH. Comparison of the anabolic effects and complications of human growth hormone and the testosterone analog,oxandrolone, after severe burn injury [ J ]. Burns, 1999; 25(3) :215-221.
18.	［17］Herndon DN, Ramzy PI, DebRoy MA, Zheng M, Ferrando AA, Chinkes DL, Barret JP, Wolfe RR, Wolf SE. Muscle protein catabolism after severe burn: effects of IGF-1/IGFBP-3 treatment [ J ]. Ann Surg, 1999 ;229 (5): 713-722.
19.	［18］Chrysopoulo MT, Jeschke MG, Ramirez RJ, Barrow RE,Herndon DN. Growth hormone attenuates tumor necrosis factor alpha in burned children [ J ]. Arch Surg, 1999; 134(3) :283-286.
20.	［19］Klein GL, WolfSE, Langrman CB, Rosen CJ, Mohan S,Keenan BS, Matin S, Steffen C, Nicolai M, Sailer DE,Hemdon DN. Effects of therapy with recombinant human growth hormone on insulin-like growth factor system components and serum levels of biochenical markers of bone formation in children after severe burn injury [ J ]. J Clin Endocrinol Metab, 1998 ;83 (1) :21-24.
21.	［20］Aarsland A, Chinkes D, Wolfe RR, Barrow RE, Nelson SO, Pierre E, Herndon DN. Beta blockade lowers peripheral lipolysis in burn patients receiving growth hormone. Rate of hepatic very low density lipoprotein triglyceride secretion remains unchanged[J ]. Ann Surg, 1996 ;223 (6): 777-789.
22.	［21］Ljungqvist O, Thorell A, Gutniak M, Haggmark T, Efendic S. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance [J ]. J Am Coll Surg, 1994; 178(4) :329-336.
23.	［22］Belcher HJ, Sheldon J, Riches P. An investigation of immunological subclass function in burned adults[J]. Burns, 1990 ;16(4) :286-290.
24.	［23］Belcher HJ, Mercer D, Judkins KC, Shalaby S, Wise S, Marks V,Tanner NS. Biosynthetic human growth hormone in burned patients: a pilot study[J]. Burns, 1989;15(2) :99-107.

1. ［1］Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary[J] ?Control Clin Trials, 1996; 17 (1): 1-12.
2. ［2］Hart DW, Wolf SE, Chinkes DL, Lal SO, Ramzy PI,Herndon DN. Beta-blockade and growth hormone after burn[J]. Ann Surg, 2002 ;236(4):450-457.
3. ［3］Hart DW, Herndon DN, Klein G, Lee SB, Celis M, Mohan S, Chinkes DL, WolfSE. Attenuation ofposttraumatic muscle catabolism and osteopenia by long? term growth hormone therapy[J]. Ann Surg, 2001 ;233(6) :827-834.
4. ［4］Jeschke MG, Barrow RE, Herndon DN. Recombinant human growth hormone treatment in pediatric burn patients and its role during the hepatic acute phase response [ J ]. Crit Care Med, 2000 ;28 (5): 1578-1584.
5. ［5］Ranirez RJ, Wolf SE, Barrow RE, Herndon DN. Growth hormone treatment in pediatric bums: a safe therapeutic approach[J]. Ann Surg, 1998 ;228(4) :439-448.
6. ［6］Gilpin DA, Barrow RE, Rutan RL, Broemeling L, Herndon DN.Recombinant human growth hormone accelerates wound healing in children with large cutaneous bums [J ]. Ann Surg, 1994;220(1):19-24.
7. ［7］Fleming RY, Rutan RL, Jahoor F, Barrow RE, Wolfe RR,Herndon DN. Effect of recombinant human growth hormone on catabolic hormones and free fatty acids following thermal injury[J]. J Trauma,1992;32(6) :698-703.
8. ［8］Gore DC, Honeycutt D,Jahoor F, Rutan T, Wolfe RR, Herndon DN Effect of exogenous growth hormone on glucose utilization in burn patients[J]. J Surg Res,1991 ;51 (6) :518-523.
9. ［9］Herndon DN, Barrow RE, Kunkel KR, Broemeling L,Rutan RL. Effects of recombinant human growth hormone on donor? site healing in severely burned children[J]. Ann Surg,1990;212(4) :424-431.
10. ［10］Xu H, Huang YS, P YZ, Liu XS, L QZ, Tian XG, Liu XB. Clinical evaluation of the effects of rhGH on the management of severely burned patients [ J ]. Chinese Journal of Burn, 2002; 18 (5) :288-291.
11. 许辉,黄跃生,彭毅志,刘旭盛,罗奇志,田学功,刘晓冰重组人生长激素应用于烧伤治疗的临床评价[J].中华烧伤杂志,2002;18(5):288-291.
12. ［11］Losada F, Garcia-Luna PP, Gomez-Cia T, Garrido M,Pereira JL, Marin F, Astorga R. Effects of human recombinant growth hormone on donor-site healing in burned adults[J]. World J Surg, 2002 ;26(1) :2-8.
13. ［12］Akcay MN, Akcay G, Solak S, Balik AA, Aylu B. The effect of growth hormone on 24 h urinary creatinine levels in burned patients[J]. Burns, 2001 ;27(1) :42-45.
14. ［13］Pelzer M, Hartmann B, Blome-Eberwein S, Raff T, Germann G. Effect of recombinant growth hormone on wound healing in severely burned adults. A placebo controlled, randomized double-blind phase Ⅱ study [ J ]. Chirurg, 2000; 71 (11):1352-1358.
15. ［14］Lal SO, Wolf SE, Hemdon DN. Growth hormone, burns and tissue healing [ J ]. Growth Horm IGF Res, 2000; 10(Suppl B) :S39-43.
16. ［15］Barret JP, Dziewulski P, Jeschke MG, WolfSE, Herndon DN. Effects of recombinant human growth hormone on the development of burn scarring [J]. Plast Reconstr Surg, 1999;104(3) :726-729.
17. ［16］Demling RH. Comparison of the anabolic effects and complications of human growth hormone and the testosterone analog,oxandrolone, after severe burn injury [ J ]. Burns, 1999; 25(3) :215-221.
18. ［17］Herndon DN, Ramzy PI, DebRoy MA, Zheng M, Ferrando AA, Chinkes DL, Barret JP, Wolfe RR, Wolf SE. Muscle protein catabolism after severe burn: effects of IGF-1/IGFBP-3 treatment [ J ]. Ann Surg, 1999 ;229 (5): 713-722.
19. ［18］Chrysopoulo MT, Jeschke MG, Ramirez RJ, Barrow RE,Herndon DN. Growth hormone attenuates tumor necrosis factor alpha in burned children [ J ]. Arch Surg, 1999; 134(3) :283-286.
20. ［19］Klein GL, WolfSE, Langrman CB, Rosen CJ, Mohan S,Keenan BS, Matin S, Steffen C, Nicolai M, Sailer DE,Hemdon DN. Effects of therapy with recombinant human growth hormone on insulin-like growth factor system components and serum levels of biochenical markers of bone formation in children after severe burn injury [ J ]. J Clin Endocrinol Metab, 1998 ;83 (1) :21-24.
21. ［20］Aarsland A, Chinkes D, Wolfe RR, Barrow RE, Nelson SO, Pierre E, Herndon DN. Beta blockade lowers peripheral lipolysis in burn patients receiving growth hormone. Rate of hepatic very low density lipoprotein triglyceride secretion remains unchanged[J ]. Ann Surg, 1996 ;223 (6): 777-789.
22. ［21］Ljungqvist O, Thorell A, Gutniak M, Haggmark T, Efendic S. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance [J ]. J Am Coll Surg, 1994; 178(4) :329-336.
23. ［22］Belcher HJ, Sheldon J, Riches P. An investigation of immunological subclass function in burned adults[J]. Burns, 1990 ;16(4) :286-290.
24. ［23］Belcher HJ, Mercer D, Judkins KC, Shalaby S, Wise S, Marks V,Tanner NS. Biosynthetic human growth hormone in burned patients: a pilot study[J]. Burns, 1989;15(2) :99-107.

Chinese Journal of Evidence-Based Medicine

Growth Hormone for Burn Patients: a Systematic Review of Randomized Controlled Trials

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