谷氨酰胺对严重创伤患者小肠黏膜损伤修复机制的影响

The empirical study of the prevention and cure mechanism of L-Glutamine on impairment of intestinal mucosal injury in severely traumatic disease patients

①目的观察严重创伤患者接受谷氨酰胺治疗后血清二胺氧化酶(DAO)、肿瘤坏死因子(TNF-α)、内毒素(LPS)水平的变化,以初步阐明谷氨酰胺促进严重创伤患者小肠黏膜损伤修复的机制。②方法将26例严重创伤患者随机分成谷氨酰胺组(GLN组)和对照组(CON组),GLN组患者给予口服谷氨酰胺(GLN)0.30g/(kg.d),疗程21天。CON组给予安慰剂。分别与伤后第1、7、14、21天晨留取患者空腹静脉血6mL。同时采集20名健康成年志愿者血清作正常对照。分别检测血清DAO、TNF-α和LPS浓度。③结果两组患者的血清DAO、TNF-α、LPS水平在第1、7、14天均明显高于正常对照组(P<0.01),第21天3组DAO、TNF-α、LPS水平差异无显著性(P>0.05)。GLN组和CON组在第1、7、14天血清DAO、TNF-α、LPS水平差异有显著性,第21天时无显著性差异。④结论GLN可以在一定程度上降低严重创伤患者血清DAO、TNF-α、LPS水平,促进小肠黏膜损伤的修复。

Objective To observe the changes of diamine oxidase （DAO） , tumor necrotic factor（ TNF - α） and endotoxin （LPS） level in serum for severely traumatic patients treated by L- glutamine（ GLN）, and elucidate mechanism of GLN on protection against intestinal mucosal injury in severely traumatic disease. Methods 26 severely traumatic patients were divided randomly into the GLN group （ 14 cases） and the control group（ 12 cases）. Patients in GLN group were treated with 0.30g· kg^ - 1. day - 1 marzulene -s granules （L -glutamine） for 21 days, while patients in the control group were treated with placebo, and 20 health adults were used as normal control group. DAO, TNF - α and LPS in serum were detected on day 1,7, 14 and 21 after injury. Results DAO concentrations in serum of patients with severely traumatic disease were higher than those of normal adults on day 1,7 and 14, while there was no significant difference among three groups on day 21 （ P 〉 0.05 ）. LPS concentration in serum of patients with severely traumatic disease were higher than those of normal adults at every time. There were no significant difference between DAO,LPS,TNF -α concentration of serum in GLN group and in control group on day 1,7 and 21, but there were significant difference on day 14 between them. Conclusions DAO, TNF - α and LPS in serum of patients with severely traumatic were reduced in a certain extent, and the intestinal mucosal integrity was repaired by GLN.