谷氨酰胺联合埃索美拉唑对重症急性胰腺炎患者氨基酸代谢、细菌移位和炎症反应的影响

Effect of glutamine combined with esomeprazole on amino acid metabolism, bacterial translocation and infl ammatory reaction in patients with severe acute pancreatitis

目的研究谷氨酰胺联合埃索美拉唑对重症急性胰腺炎(severe acute pancreatitis,SAP)患者氨基酸代谢、细菌移位(bacterial translocation,BT)以及炎症反应的影响.方法根据治疗方法的不同,将70例SAP患者随机分为两组,即只接受埃索美拉唑治疗的对照组和接受谷氨酰胺联合埃索美拉唑治疗的观察组,比较两组患者的氨基酸代谢、肠道BT以及炎症反应.随机方法是通过计算机产生随机数来实现的.结果在氨基酸代谢方面,对照组的血清色氨酸、组氨酸、赖氨酸、精氨酸、苯丙氨酸、缬氨酸、异亮氨酸含量均低于观察组,且差异具有统计学意义(P<0.05);在肠道BT方面,对照组患者粪便的乳酸杆菌、双歧杆菌数目低于观察组,金黄葡萄球菌、大肠杆菌、念珠菌数目高于观察组,差异有统计学意义(P<0.05);在炎症反应方面:对照组血清的白介素-6、超敏C反应蛋白、肿瘤坏死因子-?的含量均高于观察组,差异有统计学意义(P<0.05).结论谷氨酰胺联合埃索美拉唑的治疗有助于改善体内氨基酸代谢、预防肠道BT、缓解炎症反应,对SAP的治疗有重要的现实意义.

AIM To evaluate the effect of glutamine combined with esomeprazole on amino acid metabolism bacterial translocation（BT） and infl ammatory reaction in patients with severe acute pancreatitis（SAP）.METHODS Seventy patients with acute severe pancreatitis were randomly divided into either a control group or an observation group. The control group was given esomeprazole alone and the observation group was treated with glutamine combined with esomeprazole. Amino acid metabolism BT and inflammatory reaction were compared between the two groups.RESULTS With regard to amino acid metabolism serum tryptophan histidine lysine arginine phenylalanine,valine,and isoleucine in the control group were all significantly lower than those of the observation group（P〈0.05）. For intestinal BT the numbers of Lactobacilli and Bifidobacteria in the control group were significantly lower than those of the observation group and the numbers of Staphylococci Escherichia and Candida were significantly higher than those of the observation group（P〈0.05）. With regard to inflammatory response serum levels of interleukin-6,hypersensitive C-reactive protein and tumor necrosis factor-a in the control group were significantly higher than those of the observation group. CONCLUSION Glutamine combined with esomeprazole therapy is helpful to improve amino acid metabolism prevent BT and reduce infl ammatory reaction in patients with SAP.