谷氨酰胺对肠内免疫治疗重度烧伤患者免疫功能紊乱及营养失衡的影响

Effects of Glutamine on Resistance Mechanism Disorders and Nutritional Imbalance of Patients with Severe Burn Treated by Enteral Immunotherapy

目的探讨谷氨酰胺对肠内免疫治疗重度烧伤患者免疫功能紊乱及营养失衡的影响。方法选择2014年1月—2015年12月收治的重度烧伤83例,将接受标准肠内营养干预的40例作为对照组,将给予标准肠内营养干预+谷氨酰胺治疗的43例作为观察组,比较两组干预前、干预后10 d营养指标、炎性因子及免疫功能指标变化,并记录两组入住ICU时间、创面愈合时间、住院时间及并发症发生率。结果与干预前比较,两组干预后氮平衡、血清白蛋白(ALB)、前白蛋白(P-ALB)、转铁蛋白(TF)、Ig G、Ig A、CD4+及观察组干预后CD4+/CD8+和白介素-10(IL-10)水平均升高,白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均降低(P<0.05)。观察组干预后P-ALB、Ig G、Ig A、CD4+、CD4+/CD8+、内毒素、IL-6、IL-10、TNF-α指标改善情况优于对照组(P<0.05)。观察组入住ICU时间、创面愈合时间及住院时间均短于对照组(P<0.05)。两组创面脓毒症发生率比较差异无统计学意义(P>0.05)。结论谷氨酰胺强化肠内营养治疗能明显改善重度烧伤患者营养状况,减轻炎性反应及增强机体免疫功能,缩短创面愈合及住院时间。

Objective To investigate effects of Glutamine on resistance mechanism disorders and nutritional imbalance of patients with severe burn treated by enteral immunotherapy. Methods A total of 83 patients with severe burn admitted between January 2014 and December 2015 were divided into control group（ n = 40）,who received standard enteral nutrition intervention,and observation group（ n = 43）,who received standard enteral nutrition intervention and Glutamine therapy. Changes of nutritional indexes,inflammatory factors and immune function indexes before and 10 d after intervention were compared in two groups. Length of ICU stay,wound healing time,length of hospital stay and incidence rate of complications were recorded in two groups. Results After intervention,levels of nitrogen balance,serum albumin（ ALB）,prealbumin（ P-ALB）,transferrin（ TF）,immunoglobulin G（ IgG）,IgA and CD4 ＋ in two groups,and values of CD4 ＋ / CD8 ＋ and interleukin-10（ IL-10） in observation group were significantly higher,while IL-6 and tumor necrosis factor-α（ TNF-α） levels were significantly lower than those before intervention（ P〈0. 05）. Improvement conditions of P-ALB,IgG,IgA,CD4 ＋,CD4 ＋ / CD8 ＋,lipopolysaccharide（ LPS）,IL-6,IL-10 and TNF-α after intervention in observation group were significantly better than those in control group（ P〈0. 05）. Values of length of ICU stay,wound healing time and length of hospital stay in observation group were significantly lower than those in control group（ P〈0. 05）. There was no significant difference in incidence rate of wound sepsis between the two groups（ P〉0. 05）.Conclusion Glutamine enhanced enteral nutrition therapy can significantly improve nutritional status,regulate inflammatory responses,enhance immune function and shorten wound healing time and length of hospital stay of patients with severe burn.