谷氨酰胺和生长激素对重症肺结核患者免疫功能的影响

Effects of glutamine and growth hormone on immune function of patients with severe pulmonary tuberculosis

目的评价谷氨酰胺与生长激素联用对重症肺结核病患者免疫功能的影响。方法选取70例重症肺结核患者，年龄25—60岁，分为两组，对照组（34例）在标准营养支持外，静脉给予谷氨酰胺治疗；观察组（36例）在标准营养支持外，静脉补充谷氨酰胺和生长激素治疗。通过检测患者治疗前和治疗后14d的血清白蛋白（ALB）、前白蛋白（PA）、C反应蛋I~（CRP）、免疫球蛋白（IgG）等体液免疫指标，以及淋巴细胞总数（LY）、CD3、CD4、CD4／CD8等细胞免疫指标，评价谷氨酰胺与生长激素联用对重症肺结核患者免疫功能的影响。结果与治疗前相比，治疗后14d，两组IgG明显提高，CRP明显下降（P〈0．05），且观察组的变化明显大于对照组（P〈0．05）；治疗后14d，观察组ALB和PA均明显提高（P〈0．05），而对照组ALB和PA水平变化不显著（P〉0．05）；治疗后14d，两组LY、CD3、CD4、CD4／CD8数值均明显提高（P〈0．05），且观察组均明显高于对照组（P〈0．05）。结论谷氨酰胺与生长激素联用能改善重症肺结核患者体液免疫和细胞免疫水平，促进体内蛋白质合成，改善患者营养状态，有利于患者的康复。

Objective To evaluate the effects of glutamine combined and growth hormone on immune function of patients with severe pulmonary tuberculosis. Methods A total of 70 patients, who suffered from severe pulmonary tuberculosis and were aged 25-60, were selected and divided into a control group （n=34） and an observation group （n=36）. The control group was treated with standard nutritional support and further treated with glutamine by vein; the observation group was treated with standard nutritional support and additionally treated with glutamine and growth hormone by vein. The effects of glutamine combined with growth hormone on the immune function in patients with severe pulmonary tuberculosis were evaluated according to the detection of humoral immunity indexes, such as ALB, PA, CRP and IgG, and that of cellular immune indexes, such as LY, CD3, CD4 and CD4/CD8 in patients 14 days before and after the treatment, Results 14 days after the treatment, the IgG in the two groups was much higher than that before the treatment, while CRP dropped greatly （P 〈 0.05）. The changes in the observation group were more obvious than those in the control group（P 〈 0.05）. 14 days after the treatment, the ALB and PA in the observation group increased significantly（P 〈 0.05）, while the changes of the levels of ALB and PA in the control group were not significant（P 〉 0.05）. 14 days after the treatment, the values of LY, CD3, CD4 and CD4/CD8 in the two groups increased greatly （P 〈 0.05）, and these values in the observation group were much higher than those in the control group （P 〈 0.05）. Conclusion The combination of glutamine and growth hormone can improve the humoral immunity and cellular immunity levels in patients with severe pulmonary tuberculosis, promote the protein synthesis in the body, improve the state of nutrition of the patients, and facilitate their recover.