早期谷氨酰胺强化肠外营养对危重患者保护机制的研究

Effect of early enriched parenteral 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患者脏器功能的影响及其与预后的关系,进一步探讨谷氨酰胺对危重患者保护的内在机制。方法选择本院急诊ICU及脑外科收治的44例危重患者,按随机原则分为常规组和Gln强化组,每组22例。两组患者均行肠内、外营养,Gln强化组另予静脉注射Gln0.4g.kg-1.d-1,连续7d。观察两组患者治疗前后体内热休克蛋白70(HSP70)、Gln水平、机械通气时间、细胞免疫功能状况。结果治疗前常规组和强化组Gln、HSP70水平比较差异无统计学意义(P均>0.05)。治疗后常规组Gln、HSP70水平较治疗前稍有增加,但差异无统计学意义;而强化组治疗后Gln、HSP70水平均较治疗前显著升高(P均<0.01),且两组治疗后Gln、HSP70水平比较差异均有统计学意义(P均<0.01)。强化组体内Gln与HSP70存在正相关性(r=0.65,P=0.001)。两组机械通气时间比较差异有统计学意义(P均<0.05)。治疗后强化组CD3、CD4、CD4/CD8与常规组比较差异有统计学意义(P<0.05)。结论危重患者早期肠外补充Gln能有效改善患者的预后,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 44 patients with parenteral nutrition（PN）for more than 7 days,admitted to emergency intensive care unit（EICU）and neurosurgical department were randomly divided into two groups,one was the control group,the other was the Gln treatment group（n=22,in each group）.Patients in two groups received PN and enteral nutrition（EN）.In addition,Gln 0.4 g/kg per day was given to patients in Gln treatment group for 7 days.Serum HSP70 and Gln concentrations were measured at admission and 7 days after the nutritional supplement.Clinical outcomes before and after treatment,and the percent of CD3,CD4 cells were observed.Results There were no significant changes in serum HSP70 and Gln level between control group and Gln treatment group before the treatment（both P〉0.05）.After the treatment,serum HSP70 and Gln level in control group increased slightly,but there was no statistical differences;they in Gln treatment group were obviously higher（both P〈0.01）,and there were statistical difference in serum HSP70 and Gln level between control group and Gln group after treatment（all P〈0.01）.HSP70 level was significantly positively correlated with Gln level in Gln group（r=0.65,P=0.001）.There were significant difference in the duration of mechanical ventilation between Gln group and control group（P〈0.05）.The CD3,CD4 and CD4/CD8 levels were signifiantly higher in Gln group than in control group after the treatment（P〈0.05）.Conclusion Early parenteral glutamine administration can improve clinical outcome by the mechanism of increasing serum HSP70 in critical patients.