肠内营养添加谷氨酰胺对烧伤患者的免疫调理作用  

Effects of glutamine enriched enteral feeding on immunoregulation in burn patients

作　　者：郭光华[1] 邓志云[1] 王艳霞[1] 邢娟娟[1] 彭燕[1] 李国辉[1] 

机构地区：[1]南昌大学第一附属医院烧伤科,330006

出　　处：《中华烧伤杂志》2007年第6期406-408,共3页Chinese Journal of Burns

基　　金：江西省教育厅科技项目

摘　　要：目的了解烧伤后早期肠内营养添加谷氨酰胺(Gln)对患者免疫调理状态的影响。方法将24例烧伤患者随机分为2组,每组12例。标准营养(EN)组:给患者喂食标准肠内营养制剂能全力;免疫营养(EIN)组:喂食能全力+Gln。分别于伤后1、4、7、10d清晨空腹抽血,检测血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TF)和免疫球蛋白IgG、IgA、IgM的浓度以及T淋巴细胞亚群CD3^+、CD4^+、CD8^+和CD4^+/CD8^+的比值。结果伤后各时相点2组患者TP、ALB、TF、CD3^+、IgM组间比较,差异均无统计学意义(P>0.05)。伤后4、7、10d,EIN组患者PAB浓度分别为(90±14)、(92±16)、(106±21)mg/L,显著高于EN组(60±15)、(64±13)、(72±17)mg/L (P<0.05)。伤后7、10d,EIN组CD4^+细胞百分比为(55±5)%、(56±5)%,明显高于EN组的(45±5)%、(49±5)%(P<0.05);CD4^+/CD8^+比值为1.92±0.31和2.36±0.36,明显高于EN组的1.53±0.27和1.72±0.42(P<0.05);IgA分别为(2.8±0.6)、(3.1±0.6)g/L,IgG为(12.1±1.3)、(14.2±1.3)g/L,显著高于EN组的IgA[(2.2±0.5)、(2.5±0.5)g/L,P<0.05]和IgG[(9.8±1.2)、(10.4±1.3)g/L,P<0.05]。结论添加Gln的肠内营养制剂可以促进免疫球蛋白IgA、IgG的合成并增加PAB浓度,改善患者营养状况,纠正免疫功能紊乱。Objective To investigate the effects of glutamine enriched enteral feeding on immunoregulation in bum patients. Methods Twenty bum patients were randomly divided into enteral nutrition（EN） group and enteral immune nutrition （EIN） group, with 12 patients in each group. Patients in EN group received a standard enteral formula, while those in EIN group received an enteral formula enriched with glutamine after hospital admission. Nutritional support was continued for 10 days. Blood samples were obtained to determine plasma level of total protein （TP） , albumin （ALB） , prealbumin （PAB） and transferrin （TF） at 1, 4 ,7,10 post-bum days（PBD）. At the same time the concentration of immunoglobulin （IgA, IgG and IgM） were determined, the percentage of CD3^＋ , CD4^＋ , CD8^＋ subpopulations of T lymphocytes, and the ratio of CD4^＋/CD8^＋ were determined by FCM. Results （ 1 ） There were no obvious difference of the plasma level of TP, ALB,TF,CD3 ^＋ ,IgM between the two groups at each time-point（ P 〉0.05）. （2） The plasma PAB contents in EIN group were significant higher than that in EN group on 4 PBD[ （90± 14 vs 60 ±15） mg/L, P 〈0.05], 7 PBD[ （92 ± 16 vs 64±13） mg/L, P 〈0.05]and 10 PBD[ （106± 21 vs72 ±16） mg/L, P 〈 0.05 ]. （3） The percentage of CD4 ^＋ subpopulation and ratio of CD4 ^＋/CD8 ^＋ in EIN group were obviously higher than those in EN group on 7 PBD[CD4 ^＋ （55 ＋5 vs45 ＋5） % , CD4 ^＋/CD8^＋（1.92 ±0.31 vs 1.53±0.27） %, P 〈0.05] and 10 PBD[CD4^＋（56 ±5 vs49±5 ）% , CD4^＋/CD8 ^＋（2.36±0.36 vs 1.72 ±0.42） , P 〈0.05]. （4） The concentration of IgA and IgG in EIN group were markedly higher than that in EN group on7 PBD[IgA（2.8 ±0.6 vs2.2±0.5 ）g/L, IgG（12.1 ±1.3 vs9.8 ±1.2）g/L, P 〈 0.05] and 10 PBD[IgA（3.1±0.6 vs2.5±0.5）g/L, IGG（14.2±1.3 vs 10.4±1.3） g/L, P 〈0.05]. Conclusion These findings suggest that glutamine enriched enteral feeding can improve nutritional status by p

关 键 词：烧伤 肠道营养 营养状况 免疫 谷氨酰胺 

分 类 号：R459.3[医药卫生—治疗学]