谷氨酰胺缺乏对危重病患者免疫及脏器功能的影响

Effect of glutamine depletion on immunity and other organ function in critically ill patients

目的探讨谷氨酰胺(G ln)缺乏对危重病患者免疫和脏器功能的影响。方法2005年1—6月急诊进入外科重症监护室(S ICU)的危重病患者40例,其急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)≥8分;同期健康志愿者10名作为对照。留取患者入S ICU后48 h内凌晨6时空腹静脉血,观察患者血G ln水平、免疫功能及各脏器指标的变化。结果危重病患者血G ln明显低于健康对照组,并与APACHEⅡ评分呈明显负相关(r=0.572,P<0.05)。免疫指标中CD 4/CD 8比例(T辅助淋巴细胞与T抑制淋巴细胞)与血G ln浓度呈明显正相关(r=0.704,P<0.05),而其他免疫指标未见明显相关性。患者单核细胞中人白细胞DR抗原(HLA DR)表达明显低于健康对照组,血G ln浓度正常组(≥420μm o l/L)单核细胞HLA DR表达也较G ln缺乏组增高,但差异无显著性。G ln正常组血浆总胆红素>19μm o l/L、氧合指数<300 mm Hg(1 mm Hg=0.133 kPa)及血肌酐>110μm o l/L的发生率均低于G ln缺乏组。死亡组血G ln浓度平均为(333.2±95.1)μm o l/L,与存活组(466.1±125.2)μm o l/L相比明显降低(P<0.05)。结论危重病患者存在G ln缺乏,血G ln水平的下降对机体免疫功能、脏器功能及预后有一定影响。

Objective To evaluate the effect of glutamine depletion on immunity and other organ function in critically ill patients. Methods Ten healthy individuals served as control group. Forty seriously ill patients [acute pathological and chronic health evaluationⅡ （APACHE Ⅱ） score≥83 admitted to the surgical critical care unit （SICU） were enrolled for study. Blood samples were collected at 6：00 am 48 hours after the admission for the determination of plasma glutamine （Gln）, and parameters pertaining to immunity and organ functions. Results The Gln levels in critically ill patients were significantly lower than that of control and negatively correlated with APACHE Ⅱ score （r=-0. 572, P〈0.05）. The CD4/CD8 ratio was positively correlated with the Gln level （r = 0. 704, P〈 0. 05）, while the monocyte HLA- DR expression lowered as compared to control. In patients with normal glutamine level, the incidence of abnormal total bilirubin 〉19μmol/L, serum creatinine 〉110μmol/L, and oxygenation index 〈300 mm Hg （1 mm Hg= 0. 133 kPa） was lower compared with those with low glutamine level （all P〈0.05）. In non - survivors Gin was significantly reduced to （333.2±95.1） μmol/L and it was significantly lower as compared to that of survivors （466.1±125.2） μmol/L （P 〈 0.05）. Conclusion In critically ill surgical patients glutamine depletion is evident, and the reduction in plasma Gln is related to immunosuppression and organ dysfunction.