谷氨酰胺缺乏对危重病患者免疫及脏器功能的影响
摘要,目的,方法,结果,结论,关键词,Effectofglutaminedepletiononimmunityandotherorganfunctioni
王新颖 李维勤 李宁 黎介寿【摘要】 目的 探讨谷氨酰胺(Gln)缺乏对危重病患者免疫和脏器功能的影响。方法 2005年1—6月急诊进入外科重症监护室(SICU)的危重病患者40例，其急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)≥8分;同期健康志愿者10名作为对照。留取患者入SICU后48 h内凌晨6时空腹静脉血，观察患者血Gln水平、免疫功能及各脏器指标的变化。结果 危重病患者血Gln明显低于健康对照组，并与APACHEⅡ评分呈明显负相关(r=0.572，P<0.05)。免疫指标中CD4/CD8比例(T辅助淋巴细胞与T抑制淋巴细胞)与血Gln浓度呈明显正相关(r=0.704，P<0.05)，而其他免疫指标未见明显相关性。患者单核细胞中人白细胞DR抗原(HLADR)表达明显低于健康对照组，血Gln浓度正常组(≥420 μmol/L)单核细胞HLADR表达也较Gln缺乏组增高，但差异无显著性。Gln正常组血浆总胆红素>19 μmol/L、氧合指数<300 mm Hg(1 mm Hg=0133 kPa)及血肌酐>110 μmol/L的发生率均低于Gln缺乏组。死亡组血Gln浓度平均为(333.2±95.1)μmol/L，与存活组(4661±125.2)μmol/L相比明显降低(P<005)。结论 危重病患者存在Gln缺乏，血Gln水平的下降对机体免疫功能、脏器功能及预后有一定影响。
【关键词】 谷氨酰胺；免疫功能；脏器功能；危重病
Effect of glutamine depletion on immunity and other organ function in critically ill patients WANG Xinying, LI Weiqin, LI Ning, LI Jieshou. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, Jiangsu, China
【Abstract】Objective To evaluate the effect of glutamine depletion on immunity and other organ function in critically ill patients. Methods Ten healthy individuals served as control group. Forty seriously ill patients 〔acute pathological and chronic health evaluationⅡ (APACHEⅡ) score≥8〕 admitted to the surgical critical care unit (SICU) were enrolled for study. Blood samples were collected at 6:00 am 48 hours after the admission for the determination of plasma glutamine (Gln), and parameters pertaining to immunity and organ functions. Results The Gln levels in critically ill patients were significantly lower than that of control and negatively correlated with APACHEⅡ score (r=0572 ......
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