重组人生长激素联合谷氨酰胺强化营养治疗对重症AECOPD免疫功能的影响

Influence of glutamine and growth hormone intensified nutrition support on the immune function in severe AECOPD

目的探讨重组人生长激素联合谷氨酰胺强化营养治疗对重症AECOPD免疫功能的影响。方法 60例重症AE-COPD病人随机分成3组,A组为对照组,标准的营养支持;B组为谷氨酰胺组,在给以标准的等氮量、等热卡的营养支持的基础上,外加静脉补充谷氨酰胺;C组为联合应用谷氨酰胺和生长激素组,在B组基础上,加用生长激素。所有病人均于治疗前和治疗第10天,测定外周血血清白蛋白、前白蛋白、C反应蛋白、免疫球蛋白G的变化;采用流式细胞分析仪测定外周血淋巴细胞总数、CD3+、CD4+、CD4+/CD8+及CD14+HLA-DR比例的变化。结果 C组与A、B组相比:前白蛋白、免疫球蛋白G和外周血淋巴细胞总数的水平均有所增加,CD3+、CD4+、CD4+/CD8+及CD1+4HLA-DR的表达水平均明显提高。结论联合应用谷氨酰胺和生长激素能促进老年危重病患者的蛋白合成,改善营养状况和免疫麻痹状态。

Objective To evaluate the impacts of glutamine and recombinant human growth hormone intensified nutrition support on the immune function in severe AECOPD.Methods 20 patients with severe AECOPD who received standard nutritional support were enrolled as control group A;20 patients with severe AECOPD who were designed as group B received standard nutritional support and glutamine;and 20 patients with severe AECOPD,who received standard nutritional support,glutamine and recombinant human growth hormone were included as group C.All subjects received anti-infection therapy,phlegm-expelling formula,bronchodilators,and mechanical ventilation.The comparisons of ALB,PAB,IgG,CRP were observed before and 10-day after treatment.Meanwhile,the variables including T-cell subsets,CD14 human leukocyte antigen（locus） DR（CD14 HLA DR）.Results Compared with group A and B,subjects in group C had a significant increase in PAB,IgG and TLC（P0.05）.The T-cell subsets,CD14 HLA DR and the number of total lymphocytes were markedly higher in group C（P0.05）.Conclusion Gln and r-hGH intensified nutrition support can improve nutritional condition and immune function,down regulate the inflammatory response in severe AECOPD.