丙氨酰谷氨酰胺对急性肺损伤/急性呼吸窘迫综合征患者的影响研究

The Effect of Alanyl-Glutamine on HSP70 and MLIS and the Duration of Mechanical Ventilation in ALI/ARDS Patients

目的探讨丙氨酰谷氨酰胺(Ala-Gln)对急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者热休克蛋白70(HSP70)、Murray肺损伤评分(MLIS)及机械通气时间的影响。方法 ALI/ARDS患者110例随机分为对照组(50例)和治疗组(60例),对照组给予常规治疗,包括治疗原发病、机械通气、液体管理及营养支持等,治疗组给予常规治疗加Ala-Gln 0.4 g.kg-1.d-1共7 d。比较两组治疗前后患者血浆HSP70水平、MLIS、机械通气时间的变化和28 d死亡率。结果治疗后治疗组血清HSP70水平较对照组明显升高,差异有统计学意义(P<0.01)。治疗后治疗组MLIS较对照组显著下降,差异有统计学意义(P<0.01)。治疗组机械通气时间(162.20±96.33)h,较对照组的(235.00±107.90)h明显缩短,差异有统计学意义(P<0.05)。治疗组28 d死亡率较对照组有所降低,但差异无统计学意义(P>0.05)。结论 ALI/ARDS患者给予Ala-Gln,可明显提高其体内HSP70的水平,降低MLIS,缩短机械通气时间。

Objective To evaluate the effect of Alanyl - glutamine on serum HSP70 concentration and Murray lung injury score （MLIS） and the duration of mechanical ventilation in ALL/ARDS patients. Methods One hundred and ten patients admitted to emergency intensive care unit were randomly divided into control group and Alanyl - glutamine group. 50 patients in the control group were given routine treatment including primary disease treatment, mechanical ventilation, fluid management and nutrition support, and 60 patients in the Alanyl - glutamine group were given Alanyl - glutamine at a dose of 0. 4 g · kg - 1· d-1 for 7 days besides the routine treatment. Serum HSP70 concentrations were measured before and after the 7th treating day. MLIS and the hours of mechanical ventilation were observed at the same time. Results After treatment, HSP70 concentrations in Alanyl -glutamine group were significantly higher than those in control group （P 〈 0. 01 ）, and MLIS were significantly decreased in Alanyl-glutamine group （P 〈0. 01 ） . The hours of mechanical ventilation in Alanyl- glutamine group （162.20 ± 96. 33） h were significantly shortened than those of the control group （235.00 ± 107.90） h （P 〈0. 05） . But there was no sing- nificant difference of mortality at day 28 between the two groups. Conclusion Alanyl - glutamine can significantly increase serum HSP70 concentrations and decrease MLIS as well as shorten the duration of mechanical ventilation in ALL/ARDS patients.