谷氨酰胺双肽对严重烧伤患者内毒素血症的影响

The effects of glutamine dipeptide on the improvement of endotoxemia in severely burned patients

目的 探讨谷氨酰胺双肽对烧伤患者血浆内毒素水平的影响。 方法 将 3 0例烧伤面积 3 0 %～ 70 % ,Ⅲ度面积 >2 0 %TBSA的患者随机分为对照组和研究组 ,研究组于伤后 1～ 12d口服谷氨酰胺双肽粉剂 0 .5 g·kg-1·d-1,对照组给予等量甘氨酸作安慰剂。检测两组伤后 1、12d血浆谷氨酰胺浓度及 1、3、6、12d血浆内毒素的浓度 ,记录 3 0d创面愈合率和总住院日。 结果 伤后第1天两组血浆谷氨酰胺浓度较正常值 (65 9.5± 3 5 .0 ) μmol/L明显下降 ,但两组间差异无显著性意义(P >0 .0 5 ) ,第 12天对照组谷氨酰胺仍处于低浓度 (4 0 1.67± 65 .42 ) μmol/L ,而研究组 (5 93 .47±68.5 1) μmol/L则接近正常 ,组间差异有显著性意义 (P <0 .0 5 )。血浆内毒素浓度伤后第 1天较正常值 (0 .0 3 3Eu/ml)均明显升高 (P <0 0 5 ) ,但两组间差异无显著性意义 (P >0 .0 5 ) ,第 3天研究组内毒素浓度为 (0 .0 47± 0 .0 17)Eu/ml低于对照组 (0 .10 7± 0 .0 3 8)Eu/ml(P <0 .0 5 )。 3 0d创面愈合率研究组 (91± 6) %明显高于对照组 (85± 8) % ;而研究组平均住院日 (5 2± 11)d明显低于对照组 (67± 2 1)d。 结论 口服谷氨酰胺双肽可以维持烧伤患者血浆谷氨酰胺浓度 ,降低血浆内毒素 。

Objective To explore the influence of glutamine dipeptide on the plasma endotoxin levels in severely burned patients. Methods Thirty burned patients with TBSA of 30-70% and Ⅲ degree burn area more than 20% were randomly divided into control (C) and study (S) groups. Glutamine dipeptide powder in dose of 0.5 g/kg/day was given orally in bolus to those patients in S group during 1-12 postburn days(PBDs). The plasma levels of glutamine were determined during 1-12 PBDs. Simultaneously, the plasma endotoxin level was detected on 1,3,6 and 12 PBDs. The wound healing rate at 30 PBD and total hospital stay days were recorded. Results The plasma glutamine levels at 1 PBD in C and S groups were obviously lower than normal level (659.5±35 μmol/L), but there was no difference between these two groups (P>0.05). The plasma glutamine levels in C group was much lower than that in S group at 12 PBD (P<0.05). The plasma endotoxin concentration on 1 PBD in these two groups increased evidently compared with the normal value (P<0.05),and there was no difference between the two groups (P>0.05).The plasma endotoxin level in S group was much lower than that in C group on 3 PBD (P<0.05). As for the wound healing rate at 30 PBD, it was markedly higher in S group than that in C group (91% vs 85%). On the other hand, the hospital stay days in S group were evidently lower than that in C group (52 vs 67). Conclusion Oral intake of glutamine dipeptide in burn patients could be beneficial to the maintenance of the plasma concentration of glutamine and in decreasing plasma endotoxin level. It would also enhance the wound healing rate at 30 PBD and shorten the hospital stay days.