谷氨酰胺和生长激素强化营养对老年危重病患者免疫调理的影响

Influence of glutamine and growth hormone intensified nutrition support on immunomodulation in critically ill elderly patients

目的探讨联合应用谷氨酰胺和生长激素对老年危重病患者免疫调理的影响。方法90例患者采用前瞻、随机、对照的方法分为3组:A组为给予标准营养支持治疗对照组;B组为给予谷氨酰胺组;C组为联合应用谷氨酰胺和生长激素组。3组患者均于治疗前及治疗后7 d和14 d分别取血测定血清白蛋白、前白蛋白、C反应蛋白(CRP)、免疫球蛋白G(IgG)的变化,外周血淋巴细胞总数、CD 3、CD 4、CD 4/CD 8及CD 14单核细胞人白细胞DR抗原(CD 14 HLA DR)比例的变化。结果与A、B组比较,C组血清白蛋白、前白蛋白和IgG的水平均进一步提高,外周血淋巴细胞总数进一步增加,CD 3、CD 4、CD 4/CD 8及CD 14 HLA DR的表达水平均明显提高(P<0.05或P<0.01);炎症反应指标CRP明显下降(P均<0.01);急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及多器官功能障碍综合征(M ODS)评分均进一步下降(P<0.05或P<0.01)。3组患者重症监护室(ICU)住院时间、机械通气时间、28 d生存率改变差异均无显著性(P均>0.05)。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,改善免疫麻痹状态,下调炎症反应。

Objective To evaluate the impacts of glutamine （Gln） and recombinant human growth hormone （rhGH） intensified nutrition support on critically ill elderly patients. Methods Ninety critically ill aged patients were included in a prospective, randomized and controlled clinical study, and randomly divided into three groups： group A （standard nutrition support）, group B （standard nutrition support＋10% Gln 100 ml/d）, group C （standard nutrition support＋ Gln 100 ml/d＋rhGH 10 U/d）. Before treatment and then 7 and 14 days after treatment, blood samples were collected for analysis of serum proteins including albumin （ALB）, pre-albumin （PAB）, C - reactive protein （CRP）, immunoglobulin G （IgG）. Meanwhile, the variables including T-cell subsets, CD14 human leukocyte antigen （locus） DR （CD14 HLA- DR）, and total lymphocytes were measured. The changes in acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） and multiple organ dysfunction syndrome （MODS） scores, the durations of intensive care unit （ICU） stay and mechanical ventilation, and 28- day survival rate were recorded. Results Comparing with group A and B, the levels of serum ALB, PAB and IgG were significantly elevated in group C. The T -cell subsets, CD14 HLA- DR and the number of total lymphocytes were markedly higher in group C （P〈0.01）, and the APACHE Ⅱ and MODS scores were decreased significantly in group C （P〈0.05 or P〈0.01 ）. The levels of serum CRP were lowered significantly in group C （P〈0.01）. There were no significant differences in the durations of ICU stay, mechanical ventilation and 28- day survival rate among three groups （all P〉0.05）. Conclusion Gin and rhGH intensified nutrition support can improve nutritional condition and immune function, downregulate the inflammatory response in the critically ill elderly patients.