早期谷氨酰胺强化肠外营养对危重病患者体内热休克蛋白70的影响

Effect of early enriched parenteral alanyl -glutamine on heat shock protein 70 （HSP70） expression in critical patients

目的探讨早期给予谷氨酰胺（Gln）强化肠外营养对危重病患者脏器功能的影响及其与预后的关系。方法选择本院急诊及神经外科重症加强治疗病房（NICU）收治的44例危重病患者，按随机原则分为常规治疗组和Gin治疗组，每组22例。两组患者均行肠内、外营养，同时Gin治疗组静脉注射Gin 0．4g·kg^-1·d^-1，连用7d；观察两组患者治疗前后体内热休克蛋白70（HSP70）、Gln含量，机械通气时间、入住ICU时间及肝、肾功能不全的发生率。结果常规治疗组和Gln治疗组治疗前Gln、HSP70水平差异无显著性（P均〉0．05）；常规治疗组治疗后Gln、HSP70水平较治疗前稍有增加，但差异无显著性；而Gln治疗组治疗后Gln、HSP70水平均较治疗前显著升高，差异有显著性（P均〈0．01），且两组治疗后Gln、HSP70水平比较差异均有显著性（P均〈0．01）。Gln治疗组体内Gln浓度和HSP70含量的变化存在显著正相关（r=0．6505，P=0．001）。两组机械通气时间和肝功能不全的发生率差异有显著性（P均〈0．05），人住ICU的时间和肾功能不全的发生率则差异无显著性（P均〉0．05）。结论给危重病患者早期肠外补充Gln能有效曲善患者的予面后,降低脏器功能不全的发生率，其机制可能与提高患者体内HSP70水平有关。

Objective To evaluate the effect of early parenteral glutamine （Gln） administration on heat shock protein （HSP70） expression and clinical outcome in critical patients. Methods Forty -four patients requiring parenteral nutrition （PN） for more than 7 days , admitted to emergency intensive care unit （EICU） and neurosurgical intensive care units （NICU） were randomly divided into two groups, one was the control group, the other was the Gin treatment group（each n= 22）. Pateints in both group received PN and enteral nutrition （EN）. In addition, glutamine 0. 4 g/kg per day was given to patients of Gin treatment group for 7 days. Serum HSP70, Gin concentrations were measured at admission and 7 days after the nutritional supplentation. Observations of clinical outcome included the length of mechanical ventilation, the length of stay in intensive care unit （ICU）, the incidence of liver and kidney dysfunction before and after treatment. Results Serum HSP70 and Gln level showed no significant changes in control group and Gln treatment group before the treatment （both P〉0. 05）, though they were mildly increased after conventional treatment compared with the control group, but without statiscally significant difference. In Gln treatment group, between serum HSP70, Gln concentrations were significantly higher than those before treatment （both P〈0. 01）, and they showed significant difference between control group and Gln group after treatment （both P〈0.01）. HSP70 level was significantly positively correlated with Gln level in critical patients （r=0. 650 5, P= 0. 001）. The ratioes of liver dysfunction and the length of mechanical ventilation showed significant difference between Gln group and control group （both P 〈 0. 05）. The ratioes of kidney dysfunction and the length of stay in ICU showed no obvious changes between two groups （both P〉0. 05）. Conclusion Early parenteral glutamine administration can improve clinical outcome, decrease the ratio of organ dysfunction possibly by the mechanism of increasing serum HSP70 in critical patients.