早期丙氨酰谷氨酰胺强化营养对危重病患者热休克蛋白及炎症因子表达的影响

The effect of early enriched parenteral alanyl-glutamine on HSP70 and cytokine expression in critically ill patients

目的探讨早期丙氨酰谷氨酰胺(Gln)肠外营养对危重病患者热休克蛋白70(HSP70)、白细胞介素6、10(IL-6、IL-10)变化的影响及对机体的保护作用。方法危重病患者44例,随机分为常规治疗组和Gln组各22例,Gln组给常规营养加Gln0.4g.kg-1.d-1,共7d,比较治疗前后患者体内HSP70、IL-6、IL-10、IL-6/IL-10及APACHEⅡ评分的变化。结果Gln组治疗后HSP70显著高于治疗前(P<0.01),IL-6、IL-6/IL-10水平明显下降(P<0.01或P<0.05),APACHEⅡ评分显著降低(P<0.05)。而常规治疗组则无上述改变。结论早期予以危重病患者Gln,可明显提高其体内HSP70的水平,降低IL-6的表达,比常规肠外营养更有利于降低机体应激水平,促进脏器功能恢复。

Objective To evaluate the effect of early parenteral glutamine on expression of HSP70,IL-6,IL-10 and the protective effect in critically ill patients. Methods Fourty-four patients requiring parenteral nutrition（PN） for more than 7 days, admitted to emergency intensive care unit and surgical intensive care units were randomly divided into control group and glutamine group（glutamine 0. 4 g ·kg^-1· d^-1, for 7 days）. Serum HSP70, IL-6, IL-10 and IL-6/IL-10 concentrations were measured before and on the 7th treating day. APACHE Ⅱ scores were observed at the same time. Results In glutamine group, HSP70 concentrations were significantly higher after treatment than those before treatment（P〈0. 01）. The levels of IL-6 and IL-6/IL-10 were lower after treatment than those before treatment（P〈0.01 or P〈0. 05）, and APACHE Ⅱ scores were lower after treatment than those before treatment（P〈0.05） as well. Conclusion Early parenteral gltuamine administration can more significantly increase serum HSP70 concentrations, decrease the level of IL-6 and stress response than conventional parenteral administration in critically ill patients.