谷氨酰胺联合乌司他丁对严重烧伤大鼠肠黏膜屏障及炎症因子的影响

Effects of glutamine combined with ulinastatin on intestinal mucosal barrier and inflammatory mediators in burned rats

目的:观察谷氨酰胺联合乌司他丁对严重烧伤所致肠黏膜损害和炎症因子的影响。方法:采用30%体表面积Ⅲ度烧伤大鼠模型,随机分成烧伤组(B)、谷氨酰胺组(G)、乌司他丁组(U)、谷氨酰胺联合乌司他丁组(G+U),各组给予等氮、等热卡、等体积的营养液。G组每天给予30%总氮量的谷氨酰胺,U组于伤后每日静注乌司他丁,G+U组联合使用谷氨酰胺及乌司他丁。观察烧伤前及烧伤后第l～7天大鼠的氮平衡变化,同时检测烧伤后血浆D-乳酸、二胺氧化酶(diamine oxidase,DAO)活性及肿瘤坏死因子(tumor necrosis factor,TNF)-α、白介素(interleukin,IL)6的含量。结果:烧伤后两组大鼠的氮平衡、D-乳酸、DAO、TNF-α及IL-6均显著高于烧伤前(P<0.01);G组的氮平衡明显高于B组,而血浆D-乳酸、DAO活性及TNF-α含量均明显低于B组(P<0.05或P<0.O1);U组TNF-α及IL-6含量显著低于B组(P<0.05,P<0.O1);G+U组D-乳酸、DAO、TNF-α、IL-6均显著低于B组。结论:谷氨酰胺和乌司他丁联合使用具有协同作用,能有效减轻烧伤后肠道损伤,降低血浆炎症介质水平。

Objective：To explore the effect of glutamine combined with ulinastatin on intestine damage and inflammatory mediators after severe burn injury.Methods：Total 174 Wistar rats were inflicted with full thickness burns in 30% total body surface area and then randomly divided into burned control （B） group,glutamine treatment （G） group,ulinastatin treatment （U） group and glutamine combined with ulinastatin treatment （G＋U） group.Isonitrogenous and isocaloric nutrition supports were provided to all groups.Rats in G group were administered with glutamine at 30% total nitrogen.U group were treated with ulinastation 40 000 IU /kg via tail vein injection.G＋U group were given both glutamine and ulinastation.Nitrogen balance,D-lactate,DAO,and the levels of plasma TNF-α and IL-6 were determined.Results：After burn injury,the nitrogen balance,D-lactate,DAO activity,and levels of TNF-α and IL-6 significantly increased.Compared with B group,nitrogen balance in G group was significantly higher,while plasma D-lactate,DAO activity and levels of TNF-α were significantly lower.Levels of TNF-α and IL-6 in U group were significantly lower than those in B group.In G＋U group,all the indexes except for nitrogen balance were significantly lower than those in B group.Conclusion：Glutamine combined with ulinastatin treatment may relieve intestine damage after severe burn injury and reduce the level of plasma inflammatory cytokines.