静脉营养对重症脓毒症患者血氨基酸谱及免疫的影响  

Impact of intravenous nutrition on plasma free amino acid spectrum and immune function for patients with sepsis

作　　者：方雪玲[1] 章云涛[1] 方强[1] 卢阳珍[1] 傅素珍[1] 

机构地区：[1]浙江大学医学院附属第一医院,浙江杭州310003

出　　处：《浙江大学学报（医学版）》2007年第3期298-302,共5页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省教育基金项目(20061418).

摘　　要：目的:探讨重症脓毒症患者游离氨基酸谱、免疫功能的变化及氨基酸静脉营养对游离氨基酸谱、免疫功能的影响。方法:将2005年2月～10月收治本院ICU的40例重症脓毒症患者随机分为2组,对照组给予葡萄糖注射液+20%中长链脂肪乳剂250ml/d,氨基酸组给予葡萄糖注射液+20%中长链脂肪乳剂250ml+8.5%复方氨基酸注射液750～1000ml/d,3d后测定血游离氨基酸、免疫球蛋白和补体,同时测得20名健康人的数值作为对照。结果:对照组患者血缬氨酸、亮氨酸、异亮氨酸、丙氨酸、丝氨酸、谷氨酸、组氨酸、脯氨酸及甘氨酸值低于健康人组,氨基酸组患者大部分氨基酸值得到提高,但丙氨酸、丝氨酸、谷氨酸、组氨酸和脯氨酸仍低于健康人组;两组患者的苏氨酸、半胱氨酸及苯丙氨酸/酪氨酸比值均高于健康人组,支链氨基酸与芳香族氨基酸的比值均低于健康人组。对照组IgM、补体C3、C4均低于健康人组,氨基酸组IgM和补体C3、C4均高于对照组,但IgM仍低于健康人组。结论:脓毒血症患者大部分血游离氨基酸水平低于健康人,同时存在氨基酸代谢障碍;补充氨基酸可以提高机体的免疫功能及大部分血氨基酸水平。Objective： To investigate the impact of intravenous nutrition on plasma free amino acid spectrum and immune function for patients with sepsis. Methods： Forty severe sepsis patients were divided into two groups：Group B （amino acids ＋ glucose ＋ fat emulsion） and Group A （glucose ＋ fat emulsion）,20 healthy individuals were enrolled as control group. The concentration of free amino acid and immune globulin were determined after 3 days. Results： In Group A, the levels of valine, leucine, isoleucine, alanine, serine, glutamic acid, histidine, proline and glycin were decreased; while the levels of threonine,cysteine,the ratio of phenylalanine and tyrosine （Phe/Tyr）were higher than those in control group. Meanwhile, peripheral blood IgM,complement C3 and C4 were decreased. In group B,all amino acid levels were improved,but the level of alanine,serine,glutamic acid,histidine and proline still lower than those in control group. Similarly, the levels of IgM, complement C3 and C4 in group B were increased. Conclusion： Intravenous nutrition can support the basal requirement of amino acid and improve the immune function of patients with sepsis.

关 键 词：脓毒症/治疗 氨基酸类/治疗应用 脂肪乳剂 静脉注射用 胃肠外营养 免疫球蛋白类/分析 补体3/分析 

分 类 号：R459.3[医药卫生—治疗学]