谷氨酰胺强化肠内营养对手术后患者脏器和免疫功能的影响

目的观察谷氨酰胺强化肠内营养对手术后患者机体免疫功能的影响。方法将符合入选标准的32例消化道手术患者按随机表分别予以肠外营养(PN组)、基础型肠内营养(EN组)和谷氨酰胺强化肠内营养(GLN组)。3组患者术后第3天开始至术后第11天,接受等氮等热卡的营养支持(92.0kJ·kg-1·d-1,0.2gN·kg-1·d-1)。观察脏器功能、外周血淋巴细胞亚群、血清免疫球蛋白、血浆谷氨酰胺水平及预后指标。结果(1)PN组出现一过性肝功能损害的患者较其他2组为多,但差异无显著性(P=0.11～0.24);(2)PN组CD3+、CD4+细胞百分比以及CD4+/CD8+的比值术后第11天低于术前水平,且其手术前后的差值明显低于其他两组(P=0.04,0.001,0.006)。GLN组术后第11天与术前CD25+细胞百分比的差值明显高于PN组(P=0.01),比较EN组也有增高趋势(P=0.07);(3)术后第11天PN组患者血浆免疫球蛋白(IgG、IgM)明显低于术前水平(P=0.04,0.05),而其他两组已恢复到术前水平;(4)术后第11天,PN组患者血浆游离谷氨酰胺水平明显低于EN组和GLN组(P=0.001);(5)EN组的营养药费用明显低于PN组(P=0.001)。结论PN组患者有较多一过性肝功能损害。在本研究条件下,肠内营养支持后可减轻免疫功能抑制,谷氨酰胺强化后这种免疫功能得到加强。     

谷氨酰胺颗粒对创伤患者蛋白代谢的影响

目的　观察服用谷氨酰胺颗粒对创伤、烧伤及大手术患者蛋白代谢的影响及可能发生的不良反应。方法　采用随机、双盲对照法 ,将受试患者分为谷氨酰胺 (glutamine,GLN)组和安慰剂对照(placebo,P)组 ,每组 6 0例 ,两组患者采用等氮、等热卡的营养支持。GLN组口服或管饲GLN 0 5 g·kg-1·d-1,对照组使用同等剂量的安慰剂 (甘氨酸 ) ,疗程为 7d。比较各组患者血浆GLN浓度、蛋白代谢、肝肾功能及不良反应发生率 ,对烧伤患者还观察了创面愈合情况和住院时间。结果两组患者血浆GLN浓度、血浆蛋白含量均明显低于正常值 ,而尿氮排量则明显增高。两组比较 ,GLN组患者使用谷氨酰胺颗粒 7d后血浆GLN浓度明显增高 (5 92 5 0± 185 2 3μmol/Lvs.4 0 7 4 1± 190 2 2 μmol/L) ,增幅达4 5 4 3% (P <0 0 1)。与之对应 ,血浆前白蛋白 (0 2 9± 0 10 g/Lvs.0 2 4± 0 0 7g/L)、转铁蛋白 (5 4 4±3 0 3g/Lvs.3 6 0± 2 0 2 g/L)含量均显著高于P组 ,升幅分别为 2 0 83%、5 1 11% (P <0 0 1) ,而尿氮排量则明显低于P组 (6 78± 4 78g/dvs.9 38± 6 0 2g/d) ,降幅为 2 7 78% (P <0 0 1)。血浆总蛋白、白蛋白含量、血尿常规及肝肾功能两组差异无显著意义 (P >0 0 5 )。少数患者出现轻微不良反应 ,如恶心、腹     

谷氨酰胺增强的胃肠外营养对结直肠癌患者术后免疫功能的影响

目的 探讨谷氨酰胺增强的胃肠外营养对结直肠癌患者术后免疫功能的影响。方法 随机选择在南方医院普外科住院治疗的40例结直肠癌患者,术后分别接受等氮、等热量常规肠外营养支持或谷氨酰胺增强的肠外营养支持(0.30～0.40g·kg~(-1)·d~(-1))1周,检测术前、术后不同时期的免疫功能包括CD3~ 、CD4~ 、CD8~ 、CD4~ /CD8~ 比值,IL-2R、NK、C3、C4、CH50、IgG、IgA、IgM及其他指标。结果 经方差分析,二组患者入院均有明显的免疫抑制,谷氨酰胺增强的肠外营养组患者的免疫功能(CD4~ 、CD4~ /CD8~ 、NK、IL-2R)在术后第4、7天与对照组相比有明显改善(P相似文献   

口服谷氨酰胺颗粒对烧创伤患者的疗效及安全性分析

目的观察口服谷氨酰胺(Gln)颗粒对烧(创)伤及大手术患者的疗效及可能发生的不良反应.方法采用随机双盲、安慰剂对照法,将受试患者分为Gln组和对照组,每组60例,两组患者采用等氮、等热量的营养支持.Gln组口服或管饲Gln 0.5 g·kg-1·d-1,对照组使用同等剂量的安慰剂甘氨酸,疗程均为7 d.比较用药前后两组患者肠黏膜屏障功能、蛋白代谢、免疫功能、肝和肾功能的变化及不良反应等. 结果伤后两组患者血浆Gln浓度明显低于正常值,而血浆二胺氧化酶(DAO)活性、内毒素含量、肠黏膜通透性[尿乳果糖/甘露醇(L/M)]及尿氮排量均明显增高;但Gln组用药7 d后血浆Gln浓度与用药前比较增加38.04%(P＜0.01).Gln组血浆前白蛋白、转铁蛋白及白细胞介素2(IL-2)含量均显著高于对照组(P＜0.01),升幅分别为21.19%、51.11%、57.54%.血浆DAO活性、L/M比值、内毒素含量及尿氮排量明显低于对照组,降幅分别为47.26%、52.18%、22.22%、27.78%(P＜0.05或0.01).两组患者的血浆总蛋白、白蛋白、血尿常规及肝、肾功能在用约前后变化不明显(P＞0.05).用药后有少数患者出现轻微不良反应如恶心、腹泻和便秘等,2～3 d后自行缓解,两组间比较,差异无显著性意义(P＞0.05).结论口服Gln能显著提高患者血浆Gln浓度,明显减轻伤后肠黏膜受损程度,并能促进机体蛋白合成,降低蛋白分解,提高机体免疫功能,且临床应用无明显不良反应.     

肝炎肝硬化腹水患者输新鲜冰冻血浆前后免疫功能的变化及意义

目的：研究肝炎肝硬化腹水患者输新鲜冰冻血浆前后免疫功能的变化及意义。方法：86例肝炎肝硬化腹水患者随机分为一般治疗组及输血浆组,治疗前后测定患者的血IgGI、gMI、gA及补体C3,C4水平,并应用流式细胞仪测定外周血的T细胞亚群。结果：肝炎后肝硬化腹水患者治疗前血IgGI、gAI、gM明显高于正常,补体C3、C4明显低于正常。治疗后血IgGI、gAI、gM明显下降、补体C3、C4明显升高,治疗后两组比较,输血浆组血IgGI、gAI、gM水平轻微高于一般治疗组,无统计学差异;但血补体C3、C4水平高于一般治疗组,有显著统计学差异（P〈0.05）。肝炎后肝硬化腹水患者治疗前外周血CD3、CD4及CD4/CD8比值较正常对照明显下降,CD8明显升高。两组治疗后CD3、CD4及CD4/CD8比值明显升高,CD8明显下降,较治疗前有显著统计学差异（P〈0.05）。治疗后两组比较,输血浆组血CD3、CD4及CD4/CD8比值显著高于一般治疗组,CD8低于一般治疗组,有显著统计学差异（P〈0.05）。结论：输注新鲜冰冻血浆能提高肝炎肝硬化腹水患者的细胞免疫及体液免疫功能。     

腹腔镜直肠癌前切除对患者机体免疫功能的影响

目的探讨腹腔镜和开腹直肠癌前切除对患者机体免疫功能的影响.方法2004年4月-2005年6月,我科行开腹和腹腔镜直肠癌前切除38例,腹腔镜组18例,开腹组20例.采用流式细胞仪测定外周血中CD3、CD4、CD8、NK细胞的百分比,采用免疫速率散射比浊法测定免疫球蛋白(IgA、M、G)以及补体C3、C4,以评定患者的免疫功能.结果患者术后24 h、96 h,开腹组和腹腔镜组CD3、CD4、CD8、血清免疫球蛋白及补体C3、C4同术前相比差异均无显著性.NK细胞,腹腔镜组术后24 h、96 h同术前相比差异无显著性,而开腹组明显低于术前.结论与开腹手术相比,腹腔镜下直肠癌前切除对患者NK细胞的影响少.     

不同脂肪乳对人中性粒细胞免疫功能的影响

目的:观察3种不同类型的脂肪乳剂[Intralipid(LCT)、Kalu(LCT/MCT)及Clin Oleic(LCT/MUFA)]在体外对人外周血中性粒细胞免疫功能的影响。方法:利用密度梯度法分离健康志愿者外周静脉血中的中性粒细胞(PMN),置于培养液中,分别加入3种脂肪乳剂,每种脂肪乳剂分对照和4种不同浓度(0.01%、0.1%、1%、10%)。利用PMN吞噬酵母菌的方法测定其吞噬功能;利用琼脂糖平板实验测定PMN的趋化功能;利用硝基蓝四氮唑(NBT)还原实验测定PMN氧呼吸爆发时氧自由基的产生情况。结果:①随着浓度的增加,LCT组和LCT/MCT组PMN的吞噬功能明显下降,而LCT/MUFA组的下降程度小于前两组;差异有统计学意义(P     

丙型肝炎病毒感染对肾移植患者免疫功能的影响

目的　探讨丙型肝炎病毒 (HCV)感染对肾移植患者免疫功能的影响。方法　提取患者外周血的淋巴细胞 ,应用碱性磷酸酶 抗碱性磷酸酶 (APAAP)酶桥联法检测CD3 、CD4 、CD8 及CD16 细胞 ;免疫沉淀法测定血清中免疫球蛋白和补体水平。结果　HCV IgG和 /或HCVRNA阳性者 (HCV阳性组 )CD4 /CD8 值为 0 .90± 0 .2 5 ,显著低于HCV阴性组的 1.46± 0 .5 4(P <0 .0 5 ) ,主要是CD4 细胞下降显著 ;HCV阳性组CD16 细胞高达 2 7.8% ,与HCV阴性组比较 ,差异有显著性 (P <0 .0 1)。HCV阳性组和阴性组的血清各免疫球蛋白和补体的差异无显著性 (P >0 .0 5 )。结论　HCV阳性的肾移植患者其免疫功能紊乱。     

肠内营养添加谷氨酰胺对烧伤患者的免疫调理作用

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、10 d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、10 d,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、10 d,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.     

谷氨酰胺对胃癌术后化疗患者肠屏障功能的影响

目的观察谷氨酰胺对胃癌术后化疗患者肠屏障功能的影响。方法40例胃癌术后第4次化疗患者随机分为对照组和试验组,化疗方案为氟尿嘧啶(5-FU)、四氢叶酸(CF)加奥沙利铂(FOLFOX方案)。试验组化疗同时口服谷氨酰胺(30g/d),对照组化疗时未口服谷氨酰胺,检测两组患者化疗前后血浆谷氨酰胺浓度、二胺氧化酶(DAO)、D-乳酸水平及粪便中肠道菌群情况。结果化疗后对照组血浆谷氨酰胺浓度较化疗前明显降低(P0.05),试验组增加并明显高于对照组(P0.01);化疗后两组血浆DAO水平较化疗前均明显升高(P0.01),对照组较试验组升高更为明显(P0.05);对照组D-乳酸水平化疗后升高(P0.05),与试验组比较差异有统计学意义;试验组患者各肠道菌群总数化疗前后无明显变化,肠道菌群接近正常比例;对照组双歧杆菌、乳杆菌较化疗前明显下降(P0.01),大肠埃希菌、肠球菌明显升高(P0.01)。结论口服谷氨酰胺可提高胃癌术后化疗患者血浆谷氨酰胺浓度,有减轻损伤、调节肠道菌群微生态平衡、保护肠屏障功能的作用。     

Low plasma glutamine after multiple trauma: relationship with intracellular glutamine in polymorphonuclear neutrophils during prolonged ICU stay

BACKGROUND: Aim of the study was to evaluate whether low plasma glutamine (GLN) is related to low intracellular GLN in stress-affected cells such as polymorphonuclear neutrophil (PMN). We hypothesized, that because low plasma GLN is assumed to have an impact on clinical outcome, stress-affected cells may also show low GLN contents. METHODS: Thirty-nine consecutive severely injured trauma patients staying at least 10 days at a surgical intensive care unit (ICU) of a university hospital were separated into two groups: group one (n = 16) with low plasma GLN (< 420 micromol/l in average during ICU stay), and group two (n = 23) with normal plasma GLN. Initial blood samples for GLN analyses were collected within 24 h of admission at ICU. Further blood samples were taken on days 5 and 10 at 08:00 hours. RESULTS: Patients in both groups showed no differences regarding demographic data, surgical interventions or infections. Acute physiology and chronic health evaluation (APACHE) II and the sequential organ failure assessment (SOFA) score and mortality rate were also comparable. During the study period, intracellular PMN GLN contents and concentrations did not differ between both groups. On the first day, intracellular PMN GLN content in the low plasma GLN group peaked at 5.01 +/- 3.06 x 10(-16) mol and in normal plasma GLN group at 4.73 +/- 2.57 x 10(-16) mol above the level of healthy individuals. In both groups, content decreased significantly towards the end of the observation period (group one: 2.79 +/- 1.59 x 10(-16) mol and group two: 2.63 +/- 1.71 x 10(-16) mol). A correspondent course could be observed for cell volumes. In contrast, variation of intracellular GLN concentrations remained within the reference range throughout the observation period: group one 836 +/- 510 micromol/l on day 1 and 582 +/- 331 micromol/l on day 10, and group two 788 +/- 428 micromol/l on day 1 and 548 +/- 356 micromol/l on day 10. No correlation between plasma GLN and intracellular GLN was found in either group. CONCLUSION: No association between low plasma GLN and low intracellular GLN in PMN was found in a cohort of severely injured trauma patients with a minimum stay of 10 days at ICU.     

Clinical and protein metabolic efficacy of glutamine granules-supplemented enteral nutrition in severely burned patients

As an abundant amino acid in the human body, glutamine has many important metabolic roles that may protect or promote tissue integrity and enhance the immune system. A relative deficiency of glutamine in such patients could compromise recovery and result in prolonged illness and an increase in late mortality. The purpose of this clinical study is to observe the effects of enteral supplement with glutamine granules on protein metabolism in severely burned patients. Forty-eight severe burn patients (total burn surface area 30-75%, full thickness burn area 20-58%) who met the requirements of the protocol joined this double-blind randomized controlled clinical trial. Patients were randomly divided into two groups: burn control group (B group, 23 patients) and glutamine treated group (Gln group, 25 patients). There was isonitrogenous and isocaloric intake in both groups, glutamine and B group patents were supplemented with glutamine granules or placebo (glycine) at 0.5 g/kg per day for 14 days with oral feeding or tube feeding, respectively. The level of plasma glutamine, plasma protein content, urine nitrogen and urine 3-methylhistidine (3-MTH) excretion were determined, wound healing rate of the burned area and hospital stay were recorded. The results showed that there were significant reductions in plasma glutamine level and abnormal protein metabolism. After supplement with glutamine granules for 14 days, the plasma glutamine concentration was significantly higher than that in B group (607.86+/-147.25 micromol/L versus 447.63+/-132.38 micromol/L, P<0.01) and the plasma prealbumin and transferrin in Gln group were remarkably higher than those in B group (P<0.01), but the concentration of total protein and albumin were not significantly changed compared with B group (P>0.05). On the other hand, the amount of urine nitrogen and 3-MTH excreted in Gln group were significantly lower than that in B group. In addition, wound healing was faster and hospital stay days were shorter in Gln group than B group (46.59+/-12.98 days versus 55.68+/-17.36 days, P<0.05). These indicated that supplement glutamine granules with oral feeding or tube feeding could abate the degree of glutamine depletion, promote protein synthesis, inhibit protein decompose, improve wound healing and reduce hospital stay.     

Glutamine granule-supplemented enteral nutrition maintains immunological function in severely burned patients

Glutamine is an important energy source for immune cells. It is a necessary nutrient for cell proliferation, and serves as specific fuel for lymphocytes, macrophages, and enterocytes when it is present in appropriate concentrations. The purpose of this clinical study was to observe the effects of enteral nutrition supplemented with glutamine granules on immunologic function in severely burned patients. Forty-eight severely burned patients (total burn surface area 30-75%, full thickness burn area 20-58%) who met the requirements of the protocol joined this double-blind randomized controlled clinical trail. Patients were randomly divided into two groups: burn control group (B group, 23 patients) and glutamine treated group (Gln group, 25 patients). There was isonitrogenous and isocaloric intake in both groups, Gln and B group patents were given glutamine granules or placebo (glycine) at 0.5 g/kgd for 14 days with oral feeding or tube feeding, respectively. The plasma level of glutamine and several indices of immunologic function including lymphocyte transformation ratio, neutrophil phagocytosis index (NPI), CD4/CD8 ratio, the content of immunoglobulin, complement C3, C4 and IL-2 levels were determined. Moreover, wound healing rate of burn area was observed and then hospital stay was recorded. The results showed significantly reduced plasma glutamine and damaged immunological function after severe burn Indices of cellular immunity function were remarkably decreased from normal controls. After taking glutamine granules for 14 days, plasma glutamine concentration was significantly higher in Gln group than that in B group (607.86+/-147.25 micromol/L versus 447.63+/-132.38 micromol/L, P<0.01). On the other hand, cellular immunity functions were improved in Gln group, such as lymphocyte transformation ratio, NPI, CD4/CD8 ratio and IL-2 compared those in the B group (P<0.05-0.01). However, for humoral immunity function such as the concentration of IgG, IgM, C3, C4, no marked changes were seen compared with the B group (P>0.05). In addition, wound healing was better and hospital stay days were reduced in Gln group (46.59+/-12.98 days versus 55.68+/-17.36 days, P<0.05). These indicated that immunological function damage is present after severe burn; supplemented glutamine granules with oral feeding or tube feeding abate the degree of immunosuppression, improve immunological function especially cellular immunity function, ameliorate wound healing and reduce hospital stay.     

Effects of enteral supplementation with glutamine granules on intestinal mucosal barrier function in severe burned patients

Glutamine is an important energy source in intestinal mucosa, the small intestine is the major organ of glutamine uptake and metabolism and plays an important role in the maintenance of whole body glutamine homeostasis. The purpose of this clinical study is to observe the protection effects of enteral supplement with glutamine granules on intestinal mucosal barrier function in severe burned patients. Forty-eight severe burn patients (total burn surface area 30-75%, full thickness burn area 20-85%) were randomly divided into two groups: burn control group (B group, 23 patients) and glutamine treated group (Gln group, 25 patients). Glutamine granules 0.5 g/kg were supplied orally for 14 days in Gln group, and the same dosage of placebo were given for 14 days in B group. The plasma level of glutamine, endotoxin and the activity of diamine oxidase (DAO), as well as intestinal mucosal permeability were determined. The results showed that the levels of plasma endotoxin, activity and urinary lactulose and mannitol (L/M) ratio in all patients were significant higher than that of normal control. After taking glutamine granules for 14 days, plasma glutamine concentration was significantly higher in Gln group than that in B group (607.86+/-147.25 microM/l versus 447.63 +/- 132.28 microM/l, P < 0.01). On the other hand, the levels of plasma DAO activity and urinary L/M ratio in Gln group were lower than those in B group. In addition, the wound healing was better and hospital stay days were reduced in the Gln group (46.59 +/- 12.98 days versus 55.68 +/- 17.36 days, P < 0.05). These results indicated that glutamine granules taken orally could abate the degree of intestine injury, lessen intestinal mucosal permeability, ameliorate wound healing and reduce hospital stay.     

联合应用谷氨酰胺和重组人生长激素对严重烧伤患者蛋白代谢的影响

目的　探讨联合应用谷氨酰胺 (Gln)和重组人生长激素 (rhGH)对严重烧伤患者蛋白代谢的影响。　方法　将 6 0例严重烧伤患者随机分为对照组、Gln组及Gln rhGH组 ,每组 2 0例。对照组患者于伤后 1～ 14d口服甘氨酸作为安慰剂 ,并行常规治疗 ;Gln组于伤后 1～ 14d口服Gln 0 5g·kg-1·d-1;Gln rhGH组患者口服Gln(剂量、时间同Gln组 ) ,且伤后 7～ 14d皮下注射rhGH 0.2U·kg-1·d-1。3组患者于伤后 1、7、14d检测其血浆Gln浓度 ,伤后 14、2 1d检测血浆白蛋白水平 ,记录伤后 30d创面愈合率和总住院日。　结果　Gln rhGH组伤后 7d血浆Gln浓度为 ( 4 5 2 .2 8± 2 1.72 )μmol/L,高于对照组 ( 32 5 .12± 2 5 .34) μmol/L(P <0.0 5)。伤后 2 1dGln rhGH组血浆白蛋白水平为( 31.37± 4 .31) g/L,高于对照组 ( 2 6 .16± 3.12 ) g/L及Gln组 ( 2 8.2 6± 3.2 9)g/L( P <0 0 5 )。伤后 30dGln rhGH组创面愈合率高于对照组及Gln组 ,而总住院日少于对照组及Gln组 (P <0.0 5或 0 .0 1)。　结论　联合应用Gln和rhGH能显著提高严重烧伤患者血浆Gln水平 ,促进机体蛋白的合成 ,提高创面愈合率。     

口服谷氨酰胺对化疗患者肠屏障功能的保护作用

目的观察谷氨酰胺对胃肠肿瘤术后化疗患者肠黏膜的保护作用。方法将胃肠道肿瘤手术后准备行化疗的39例患者分成观察组(22例)和对照组(17例),化疗方案为氟尿嘧啶(5-FU)加四氢叶酸(CF),连续5d。观察组化疗同时口服谷氨酰胺颗粒30g/d,分3次服,连续7d;对照组仅化疗。检测两组患者化疗前后血浆中谷氨酰胺浓度和尿中乳果糖/甘露醇(L/M)比值。结果观察组化疗后血浆中谷氨酰胺浓度为(594.44±81.26)μmol/L,较对照组的(535.42±53.75)μmol/L明显增高(P<0.01);尿中L/M比值治疗组(0.0321±0.0052)较对照组(0.0453±0.007)明显降低(P<0.01)。结论口服谷氨酰胺颗粒能够提高胃肠肿瘤术后化疗患者血谷氨酰胺浓度,减轻化疗后肠黏膜损伤程度,维护肠黏膜屏障功能。     

谷氨酰胺双肽对严重烧伤患者内毒素血症的影响

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 ,促进创面愈合     

Beta-hydroxy-beta-methylbutyrate supplementation in critically ill trauma patients

BACKGROUND: Negative nitrogen balance and skeletal muscle loss are common in critically injured patients and may contribute to morbidity, mortality and resource utilization. Juven, an enteral supplement which is a combination of beta-hydroxy-beta-methylbutyrate (HMB), arginine (ARG), and glutamine (GLN) has been shown to restore muscle in cachetic acquired immunodeficiency syndrome (AIDS) and cancer patients. More recently HMB has been shown to attenuate cancer-induced muscle loss by decreasing muscle proteolysis. The purpose of this study was to analyze whether HMB alone or in combination with ARG and GLN would have a similar effect on critically injured trauma patients. We hypothesized that nitrogen balance would be improved and muscle proteolysis decreased with HMB and HMB/ARG/GLN supplementation. METHODS: There were 100 adult trauma patients with Injury Severity Score (ISS) >18 were enrolled in this prospective, randomized, blinded study. All patients received standard tube feeds and one of three iso-nitrogenous supplements; HMB, HMB/ARG/ GLN, or placebo (PLAC) for 28 days. Urine, serum, and clinical data were collected for 72 patients receiving at least 7 days of supplementation during the first 14 days of treatment. Urinary 3-methylhistidine (3-MH) was used as a proxy for muscle proteolysis. RESULTS: The three groups were similar in age, gender, mechanism, and severity of injury, with the average ISS being 31.9. Utilizing covariant (ISS) repeated measure (days 1-14) mixed model (SAS) analysis, there was a significant treatment effect (p = 0.05) on nitrogen balance (g/d). Change in nitrogen balance from the first 7 days to the last 7 days was -4.3 for the HMB and -5.6 g/d HMB/ARG/GLN groups compared with -8.9 g/d for the PLAC group. 3-MH to creatinine ratios were not different in the PLAC group as compared with the HMB/ARG/GLN and HMB groups (Treatment Effect, p = 0.80). CONCLUSIONS: These data suggest that supplementation with HMB alone may improve nitrogen balance in critically injured adult patients and that this effect is not a result of lowered muscle protein turnover as originally hypothesized.