补充谷氨酰胺对脓毒症血液滤过患者HLA-DR表达及疗效的影响

Effects of glutamine supplement on HLA-DR expression and efficacy in sepsis patients treated by CVVH

目的探讨连续性血液过滤(CVVH)治疗的脓毒症患者适量补充谷氨酰胺,对其细胞免疫功能及临床疗效的影响。方法选择2016年1月至2017年6月本院重症医学科住院的56例脓毒症合并急性肾功能不全病例,随机分为谷氨酰胺组(n=30)和常规组(n=26)。谷氨酰胺组患者CVVH开始后即给予丙氨酰-谷氨酰胺注射液10 g每天2次,持续静脉滴入,疗程3 d。抽取静脉血检测2组患者治疗前及治疗后血清白蛋白(ALB)、前白蛋白(PA)、血肌酐(Cr)、降钙素原(PCT)水平;检测2组患者治疗前后外周血单核细胞HLA-DR水平,同时计算2组患者治疗前后APACHEⅡ评分。结果治疗后,谷氨酰胺组ALB及PA数值均明显高于常规组(P<0.01),PCT水平明显低于常规组(P<0.01),单核细胞HLA-DR水平明显高于常规组(P<0.01),APACHEⅡ评分数据低于常规组(P<0.01)。结论脓毒症患者CVVH治疗过程中存在明显的负氮平衡,补充适量谷氨酰胺后,可以有效改善患者营养状况,提高患者的细胞免疫功能,对临床治疗有所帮助。

This study was performed to discuss the effects of glutamine supplementation on the cellular immune function and clinical efficacy in CVVH-treated sepsis patients. Total of 56 cases of sepsis cases complicating acute renal insufficiency were recruited from critical care medicine department of our hospital from January 2016 to June 2017, and randomly divided into glutamine group （n=30） and conventional group （n=26）. The patients in glutamine group were given alanylglutamine 10 g/bid via intravenous injection for continuous 3 days after CVVH. The serum albumin （ALB）, prealbumin （PA） and calcitonin （PCT） levels were detected before and after treatment in the two groups of patients; the HLA-DR level in the peripheral blood monocytes and APACHEII score of the two groups were detected before and after treatment. Data showed that the levels of albumin and prealbumin in glutamine group were significantly higher than that in conventional group after treatment （P〈0.01）; the PCT level of glutamine group was significantly lower than that of the conventional group （P〈0.01）; the HLA-DR level of monocytes in glutamine group after treatment was significantly higher than that of the conventional group （P〈0.01）. After treatment, the APACHEII score of glutamine group was lower than that of the conventional group （P〈0.01）. Thus, we concluded that negative nitrogen balance is involved in CVVH treatment process of sepsis, and suitable glutamine supplementation can improve the nutritional status of sepsis patients by improving cellular immune function.