谷氨酰胺对重症患者术后应激反应和免疫功能的调节作用

Modulating effect of glutamine on stress reaction and immune function in postope rative critical patients

目的 探讨谷氨酰胺对重症患者术后应激反应和免疫系统的调节功能。方法 把经手术治疗进入外科重症监护病房 (SICU)的危重患者随机分为常规全肠道外营养 (TPN)组 (对照组 )和谷氨酰胺加强的TPN组 (谷氨酰胺组 ) ,观察两组的术后应激反应情况和免疫学指标变化情况。结果 术后谷氨酰胺组患者的白细胞、C反应蛋白 (CRP)、皮质醇和高密度脂蛋白的下降速度较对照组快 (P <0 .0 5 ) ;两组的胆固醇含量均于术后第 3天上升 ,至第 7天下降 ,以谷氨酰胺组下降速度为快 (P <0 .0 5 ) ;两组儿茶酚胺的浓度均下降 ,但差异无显著性。术后谷氨酰胺组CD3和CD4 /CD8比值较对照组上升快 (P <0 .0 5 ) ;两组IgG和IgA水平均上升 ,但谷氨酰胺组上升较慢 (P <0 .0 5 ) ;谷氨酰胺组CD2 5上升缓慢 ,而对照组于术后第 3天急速上升后又迅速下降 (P <0 .0 5 ) ;两组自然杀伤 (NK)细胞含量均下降 ,以谷氨酰胺组下降更快 (P <0 .0 5 ) ;两组IgM于术后第 7天均稍上升 ,但差异无显著性。结论 谷氨酰胺能减轻重症患者术后的应激反应并能调节危重患者术后早期紊乱的免疫功能。

Objective To appraise the modulating effect of glutamine on stress reaction and immune fun ction in postoperative critical patients. Methods Clinical postoperative patients were divided into TPN group and TPN plus glutam ine group. The changes in stress reaction and immune function were observed. Results The reaction rates of WBC, CRP,HDC of glutamine group decreased more rapidly tha n t hose of the TPN group, whereas the CD3, CD4/CD8 of glutamine group increased mor e rapidly than those of the TPN group. Conclusion Glutamine can reduce the degr ee of stress reaction and regulate the immune function of the postoperative crit ical patients.