谷氨酰胺对重症颅脑损伤患者营养状态炎症介质释放和肠道屏障功能的影响  

Effects of glutamine on nutritional status,release of inflammatory mediators and intestinal barrier function in patients with severe head injury

作　　者：罗凯[1] 曲军[1] 刘飞皎[1] 杨文涛 LUO Kai;QU Jun;LIU Feijiao;YANG Wentao(The First People's Hospial of Nanyang,Nanyang 473000,China;Kaifeng Central Hospial,Kaifeng 475000,China)

机构地区：[1]南阳市第一人民医院,河南南阳473000 [2]开封市中心医院,河南开封475000

出　　处：《中国实用神经疾病杂志》2021年第19期1713-1723,共11页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20191175)。

摘　　要：目的研究添加免疫调节剂的肠内营养支持对重症颅脑损伤(SHI)患者营养状态、炎症介质释放和肠道屏障功能的影响。方法将2017-06—2020-06南阳市第一人民医院收治的94例SHI患者分为谷氨酰胺(Gln)组和常规组各47例,2组均给予常规治疗和早期肠内营养,Gln组在营养液中添加谷氨酰胺,比较14 d时2组患者营养水平、免疫功能、炎症因子、肠道屏障功能及相关并发症发生情况。结果治疗14 d时,2组血清总蛋白(TP)、白蛋白(ALB)、转铁蛋白(TRF)及格拉斯哥昏迷量表(GCS)评分均明显升高(P<0.05),常规组三头肌皮褶厚度(TSF)和上臂肌围(AMC)明显降低(P<0.05),且Gln组TP、ALB、TRF、TSF、AMC及GCS均高于常规组。2组免疫球蛋白A(IgA)、IgG、CD4^(+)及CD4^(+)/CD8^(+)均明显升高(P<0.05),CD8^(+)均明显降低(P<0.05),且Gln组IgA、IgG、CD4^(+)及CD4^(+)/CD8^(+)高于常规组,CD8^(+)低于常规组。2组白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及可溶性髓样细胞触发受体-1(sTREM-1)均明显降低(P<0.05),且Gln组TNF-α、IL-6及sTREM-1低于常规组。2组D-乳酸、降钙素原(PCT)及二胺氧化酶(DAO)明显降低(P<0.05),且Gln组D-乳酸、PCT及DAO低于常规组,Gln组胃肠道不适及肺部感染发生率低于常规组,差异有统计学意义(P<0.05)。结论在SHI患者肠内营养中添加谷氨酰胺可有效保护肠黏膜屏障结构和功能,改善机体免疫功能,抑制炎症介质释放,减少感染等并发症,对维持机体营养水平和促进患者康复具有重要意义。Objective To study the effect of enteral nutrition support with immunomodulator on nutritional status,release of inflammatory mediators and intestinal barrier function in patients with severe head injury(SHI).MethodsTotally 94 patients with SHI treated in Nanyang First People’s Hospital between June 2017 and June2020 were divided into Gln group and conventional group,with 47 cases in each group.The two groups were given conventional treatment and early enteral nutrition,and Gln group was added with glutamine in nutrient solution.The nutritional level,immune function,inflammatory factors,intestinal barrier function and occurrence of related complications were compared between the two groups at 14 days.ResultsAt 14-day of treatment,the levels of serum total protein(TP),albumin(ALB)and transferrin(TRF)and Glasgow coma score(GCS)were significantly increased in the two groups(P<0.05),and the triceps skinfold thickness(TSF)and upper arm muscle circumference(AMC)in conventional group were significantly decreased(P<0.05),and and the TP,ALB,TRF,TSF,AMC and GCS in Gln group were higher than those in conventional group.The immunoglobulin A(IgA),IgG,CD4^(+)and CD4^(+)/CD8^(+)in the two groups were significantly increased(P<0.05),while the CD8^(+)was significantly decreased(P<0.05),and the IgA,IgG,CD4^(+)and CD4^(+)/CD8^(+)in Gln group were higher than those in conventional group while the CD8^(+)was lower than that in conventional group.The levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and soluble triggering receptor expressed on myeloid cell-1(sTREM-1)were significantly decreased in the two groups(P<0.05),and the levels of TNF-α,IL-6 and sTREM-1 in Gln group were lower than those in conventional group.The levels of D-lactic acid,procalcitonin(PCT)and diamine oxidase(DAO)were significantly reduced in the two groups(P<0.05),and the levels of D-lactic acid,PCT and DAO in Gln group were lower than those in conventional group,and the incidence rates of gastrointestinal discomfort and lung infection were lower

关 键 词：重型颅脑损伤 肠内营养支持 谷氨酰胺 炎症介质 肠道屏障功能 

分 类 号：R651.15[医药卫生—外科学]