丙氨酰-谷氨酰胺对危重症患者肠屏障功能及免疫功能的影响研究

Effects of Alanyl-Glutamine on Intestinal Barrier and Immunity Function in Critically Ill Patients

目的观察丙氨酰-谷氨酰胺对危重症患者肠屏障功能及免疫功能的影响。方法选择2008年9月—2012年7月入住我科的危重症患者30例,按照住院顺序分为A组、B组和C组,每组10例。各组患者均针对原发病进行相应的基础治疗,A组患者静脉给予丙氨酰-谷氨酰胺双肽0.5 g·kg-1·d-1,连续7 d;B组患者通过鼻饲给予丙氨酰-谷氨酰胺双肽0.5 g·kg-1·d-1,连续7 d,C组仅给予基础治疗。检测各组患者治疗前、治疗后第7天血浆谷氨酰胺水平、尿乳果糖/甘露醇比值(L/M)、血浆二胺氧化酶(DAO)、血浆可溶性白介素-2受体(SIL-2R)水平、血浆白介素-6(IL-6)水平。结果治疗前,3组患者血浆谷氨酰胺、DAO、SIL-2R、IL-6水平及L/M比较,差异均无统计学意义(P>0.05);治疗后比较,差异均有统计学意义(P<0.01),且以上指标组间两两比较,差异均有统计学意义(P<0.01)。结论肠内或肠外应用丙氨酰-谷氨酰胺可提高危重症患者血浆谷氨酰胺水平,改善其肠屏障功能,提高机体细胞及体液免疫功能,且相对于肠内营养,肠外营养可获得更佳的疗效。

Objective To study the effects of Alanyl - Glutamine （Aln - Gin） on intestinal barrier and immunity function in critically ill patients. Methods Thirty critically ill patients admitted into our ward between September 2008 and July 2012 were included in the study. They were divided into three groups （n = 10 for group A, B, and C） based on chronological order of their admission. All groups were given basic treatment to their primary diseases. Patients in group A were given intrave- nous administration of Aln - Gin dipeptide, 0. 5 g·kg-1·d-1, for 7 days; Patients in group B were given nasal feeding of Aln - Gin dipeptide, 0. 5 g·kg-1·d-1, for 7 days; While group C did not receive other therapy than basic treatment. Urine laetu- lose/mannito （L/M） ratio, levels of plasma glutamine （ Gin）, diamine oxidase （ DAO）, soluble interleukin - 2 receptor （ SIL - 2R）, and interleukin - 6 （ IL - 6） were measured before the treatment and at day 7 after the treatment. Results There was no significant difference in L/M ratio, levels of plasma Gin, DAO, SIL - 2R, and IL - 6 among the three groups before the treatment （P 〉0. 05）, but there was after the treatment （P 〈0. 01 ）. There were significant differences in the above mentioned measurements between each two of the groups （P 〈 0. 01 ）. Conclusion Parenteral and enteral administration of Aln - Gin dipeptide can increase the level of plasma Gin in critically ill patients, therefore improving their intestinal barrier and immunity function. In addition, parenteral approach might be more effective than enteral approach.