谷氨酰胺联合肠内营养对重型颅脑损伤患者免疫功能的影响

Effects of Glutamine Combined with Enteral Nutrition on Immune Function in Severe Craniocerebral Injury Patients

目的:探讨谷氨酰胺联合肠内营养对重型颅脑损伤患者血清缺氧诱导因子-1α(HIF-1α)、胶质纤维酸性蛋白(GFAP)、组织型纤溶酶原激活物(t-PA)与Toll样受体(TLR)表达水平的影响。方法:选取2018年1月~2020年12月期间本院收治的90例重型颅脑损伤患者为研究对象,按随机数字表法分为对照组和观察组,每组45例。对照组进行常规肠内营养治疗,观察组在对照组治疗基础上加服谷氨酰胺颗粒。比较两组患者的HIF-1α、GFAP、t-PA、TLR表达水平;分别采用美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷量表(GCS)评价患者的神经功能及意识状态;采用格拉斯哥预后量表(GOS)评价患者预后情况。结果:观察组血清HIF-1α、GFAP、t-PA和TLR4水平均低于对照组(P<0.05);观察组治疗后NIHSS评分低于对照组,GCS评分高于对照组(P<0.05);观察组患者的预后良好率高于对照组(P<0.05)。结论:谷氨酰胺联合肠内营养可有效减轻重型颅脑损伤患者的应激反应,改善其免疫功能、营养状态、神经功能和意识障碍程度,提高临床疗效。

Objective:To investigate the effects of glutamine combined with enteral nutrition on serum hypoxia-inducible factor-1α(HIF-1α),glial fibriuary acidic protein(GFAP)and tissue-type plasminogen activator(t-PA)levels and Toll-like receptors(TLR)in severe craniocerebral injury patients.Methods:A total of 90 patients with severe craniocerebral injury who were treated in our hospital from January 2018 to December 2020 were selected as research subjects,and divided into the control group and the observation group according to the random number table method,with 45 patients in each groups.The control group received routine enteral nutrition treatment,and the observation group took glutamine granules in addition to the treatment of the control group.The expression levels of HIF-1α、GFAP、t-PA、TLR in the two groups were compared.National Institutes of Health stroke scale(NIHSS)and Glasgow coma scale(GCS)were used to evaluate the neurological function and consciousness state of the patients.The patients’prognosis was evaluated by the Glasgow outcome scale(GOS).Results:The serum levels of HIF-1α,GFAP,t-PA and TLR4 in the observation group were lower than those in the control group(P<0.05).The NIHSS score of the observation group was lower than that of the control group,and the GCS score of the observation group was higher than that of the control group(P<0.05).The rate of good prognosis in observation group was significantly higher than that in control group(P<0.05).Conclusion:Glutamine combined with enteral nutrition can effectively relieve the stress response of patients with severe craniocerebral injury,improve their immune function,nutritional state,neurological function and consciousness disorders,and improve the clinical efficacy.