谷氨酰胺增强结肠直肠切除病人的T淋巴细胞反应

Glutamine-supplemented parenteral nutrition enhances T-lymphocyte response in surgical patients undergoing colorectal resection

研究目的:作者测定了在行直结肠切除的患者中,谷氨酰胺强化的肠外营养支持对手术后外周血T细胞反应及炎症细胞因子生成的影响。 背景资料:包括免疫系统在内的几种有机体组织的正常功能依赖于谷氨酰胺;然而这种氨基酸,虽然可能为应激状态所必需,近年才正式将它用于肠外营养液中。这种强化的肠外营养液对处于应激状态的外科病人的免疫功能的影响尚不清楚。 研究方法:患者(n=20)随机分为两组,在术后1～6天,一组接受传统的肠外营养液治疗(每天0.2克氮/kg),另一组每天接受含有0.188/kg谷氨酰胺的等氮等热卡方案治疗。分别在术前和术后第1～6天,体外测定:T细胞DNA合成、IL-2的生成情况以及外周血单核细胞IL-6和肿瘤坏死因子(TNF)的生成情况。 研究结果:行肠外营养治疗5天后,与术前相比,T细胞DNA的合成在谷氨酰胺强化组病人中增加了(术前~3H标记的胸腺嘧啶的平均摄取为78.3×103cpm;第6天为95.0×103cpm,P【0.05),而在对照的治疗组患者中,T细胞DNA合成没有增加(术前为89.0×103cmp,第6天为69.4×10~3cpm,P【0.05)。添加谷氨酰胺并不影响IL-2,TNF和IL-6的生成水平。 结论:添加谷氨酰胺可能是增强接受肠外营养治疗的外科病人的T细胞功能的一种方法。

The authors determined the effect of glutamine-supplementation of PN on postoperative peripheral blood T-cell response and proinflammatory cytokine production in patients undergoing colorectal resection. Background: Several vital tissues, including the immune system, are very dependent on glutamine; however, this amino acid, which may be essential in condition of stress, only now is becoming formulated suitably for incorporation into PN. The effects of such supplementation on the immune function of stressed surgical patients is unknown. Methods:Patients(n =20)were randomized to receive conventional PN(0.2g nitrogen/kg/d)or an isonitrogenous/isocaloric regimen with 0. 18g of glutamine/kg/d from days 1 to 6 postoperatively. T-cell DNA synthesis and interleukin (IL-2) production and peripheral blood mononuclear cell IL-6 and tumor necrosis factor(TNF) production were measured in vitro preoperatively and on days 1 and 6 postoperativ-ely. Results:T-cell DNA synthesis after 5 days of PN was increased compared with preoperative values in the glutamine-supplemented group(median pre-operative tritiated thymidine uptake:78. 3×103cpm, day 6:95.0×103 cmp, P < 0.05 ) . There was no such increase in the control PN group (preoperative: 89.0×103cpm,day 6;69. 4×103cpm, P >0.05) . Glutamine supplementation did not influence IL-2 production or the production of TNF or IL-6. Conclusions: Glutamine supplementation may be a method of enhancing T-cell function in the surgical patient receiving PN.