盐酸精氨酸和醋酸精氨酸对烧伤家兔免疫功能及酸碱平衡影响的对比研究

目的观察盐酸精氨酸与醋酸精氨酸对严重烧伤家兔机体免疫功能和酸碱平衡的影响。方法选用110只大耳白兔,取其中8只作为正常对照组;余下102只造成30%TBSAⅢ度烧伤后,根据灌喂不同种类及不同剂量的药物分为烧伤对照组,0.3、0.6、1.2、2.4g/kg盐酸精氨酸组和同种剂量的醋酸精氨酸组,每组兔数10~14只。烧伤对照组家兔伤后仅腹腔注射林格液抗休克,不灌喂药物;其他各组除同烧伤对照组行抗休克处理外,还分别按上述剂量灌喂药物,2次/d,连续7d。观察各组家兔免疫功能、血气分析、Cl-代谢及死亡率的变化。结果烧伤对照组家兔免疫功能紊乱,变化趋势呈先高后低,伤后7d淋巴细胞转化率、CD4/CD8比值、白细胞吞噬率和白细胞趋化指数均明显低于正常对照组(P<0.01);1.2、2.4g/kg盐酸精氨酸、醋酸精氨酸组伤后7d前述4项指标均明显高于烧伤对照组(P<0.05或0.01)。伤后7d,2.4g/kg盐酸精氨酸组pH值、剩余碱、缓冲碱、HCO3-浓度均较同剂量醋酸精氨酸组明显降低(P<0.05或0.01);前组各项指标均明显低于正常对照组(P<0.05或0.01),后组与正常对照组比较变化不明显。2.4g/kg盐酸精氨酸组伤后5、7d血浆Cl-含量明显高于同剂量醋酸精氨酸组和正常对照组(P<0.05或0.01)。0.3、0.6、1.2g/kg盐酸精氨酸、醋酸精氨酸组家兔死亡率明显低于烧伤对照组(P<0.05或0.01),而2.4g/kg醋酸精氨酸、盐酸精氨酸组死亡率高于烧伤对照组及其他剂量组(P<0.05)。结论家兔严重烧伤后免疫功能下降,盐酸精氨酸和醋酸精氨酸都能有效提高机体免疫功能,疗效相当,醋酸精氨酸的安全性明显优于盐酸精氨酸;两种精氨酸的剂量都不宜过大,否则会致死亡率上升。

Comparative study on the influence of arginine hydrochloride and arginine acetate on the immune function and acid-base balance in rabbits with severe burns

Objective To investigate the influence of arginine hydrochloride and arginine acetate on the immune function and acid-base balance in rabbits with severe burns. Methods One hundred and ten flap-eared rabbits were used in the study, in which 8 served as normal control, while the rest were inflicted with 30% TBSA full thickness burn. All the rabbits were divided into 10 groups, i.e. normal control(C,n=14),burn control (B, n=14, with intravenous infusion of Ringer's solution), 0.3g/kg arginine hydrochloride (AH, n=12), 0.3g/kg arginine acetate (AA, n=10), 0.6g/kg AH(n=10), and 0.6g/kg AA(n=10) groups, 1.2 g/kg AH(n=10), 1.2g/kg AA(n=10) , 2.4 g/kg AA(n=14) and 2.4g/kg AH(n=12) groups. AA and AH in different doses were fed to rabbits in corresponding groups 2 times a day for 7 days. The changes in the immune function, acid-base balance, chlorideion metabolism, and mortality were determined. Results Disorder in immune system was found after severe burns, with enhanced immune function at the beginning and weakening afterwards. The lymphocytic transformation rate, the CD4/CD8 ratio, the phagocytosis rate and the chemotactic index of white blood cells on 7 post burn day (PBD) were obviously lower in B group compared with C group (P<0.05 or 0.01). These indices were obviously higher in 1.2, 2.4g/kg AA and AH groups than those in B group on 7 PBD (P<0.05 or 0.01). There was no difference in improvement of immune functions between 0.3,0.6g/kg AH, AA group and B group. The values of blood pH, base excess (BE), buffer base (BB), HCO_3~- level in AH group were significantly lower than those in C group on 7 PBD (P<0.05 or 0.01), while there were no obvious changes in AA group, they were obviously higher than those in AH group(P<0.05 or 0.01). The contents of chlorideion in but 2.4g/kg AH group during 5 to 7 PBD were obviously higher than those in C group and 2.4g/kg AA group (P<0.05 or 0.01), while no difference was found between 2.4g/kg AA and C groups. The mortality in B group was obviously higher than that in 0.3, 0.6, 1.2 g/kg AH and AA groups (P<0.05 or 0.01), but significantly lower than that in 2.4g/kg AA and AH groups(P<0.05). Conclusion Disorders in immune fu- nctions were observed in severely burned rabbits. Administration of arginine acetate as well as arginine hydrochloride could enhance the immune function, but arginine acetate seemed to be safer than arginine hydrochloride. Excessive dosage should be avoided to prevent a rise of the mortality.