黄芪联合谷氨酰胺对脓毒症休克患者血浆一氧化氮二胺氧化酶的影响及意义

目的 探讨黄芪与谷氨酰胺联用在脓毒症休克所致肠黏膜缺血/再灌注损伤时的保护作用.方法 选择2005-12～2008-10期间重症监护病房(ICU)符合诊断标准的脓毒症休克患者69例,全部患者按2004年脓毒症诊治指南的规范集束治疗,包括早期目标液体复苏、抗生素治疗、呼吸机治疗、激素治疗、血糖控制等.采用随机对照方法分为三组,各组均实施低热量肠外营养(TPN)治疗,A组为低热量常规TPN对照组,B组为加用谷氨酰胺组,C组为黄芪联合谷氨酰胺组,分别于治疗前及治疗后第1、3、5、7天测定血浆一氧化氮(NO)水平、二胺氧化酶(DAO)活性,并记录急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ),终末观察指标为多器官功能障碍综合征(MODS)发生率、ICU住院时间、28 d病死率.结果 三组治疗前各指标比较差异均无统计学意义(P＞0.05).与A组比较,C组治疗后NO水平进一步下降,第1、3、5天下降明显(P＜0.01);与B组比较,C组NO水平亦下降(P＜0.05),第7天比B组稍偏高,但两组比较差异无统计学意义(P＞0.05).与A组比较,C组治疗后DAO活性逐渐下降,第3、5、7天下降明显(P＜0.01);C组DAO活性与B组比较差异亦有统计学意义(P＜0.05).与A组、B组比较,C组治疗后APACHEⅡ评分、MODS发生率、28 d病死率均下降(P＜0.05).与A组比较,B组、C组ICU住院时间稍有缩短,但差异无统计学意义(P＞0.05).结论 黄芪联合谷氨酰胺加强免疫营养治疗可保护脓毒症休克所致的肠黏膜损伤,并改善患者预后,这与抑制NO的大量产生有关.

Impact of astragalus combined with glutamine on the concentration of nitric oxide and diamine oxidase in the plasma of the patients with septic shock

Objective To study the impact of astragalus combined with glutamine for strengthe-ning immune nutrition on the concentration of nitric oxide( NO) , diamine oxidase( DAO) in the plasma of the patients with septic shock, and to explore the protective effect of astragalus combined with gluta-mine on intestinal mucosa ischemia/reperfusion injury induced by the septic shock. Methods 69 pa-tients consisted with diagnostic criteria of septic shock in the intensive care unit ( ICU) from December 2005 to October 2008. Each patient was treated with cluster norms therapy under the Diagnosis Guide-lines of Sepsis in 2004, which included early target fluid resuscitation, antibiotic therapy, respirator treatment, hormone therapy, blood glucose control, etc. The patients were divided into 3 groups by ran-domized controlled methods. Group A was control group with low - calorie conventional TPN. Group B ( glutamine) and C ( glutamine with astragalus) were treatment groups with low - calorie TPN treatment. We tested the concentration of NO and DAO in the plasma before TPN and at 1, 3, 5, 7 day after TPN. We also recorded the APACHE II score, and observed incidence of MODS, days in ICU and 28 - day mortality. Results Results before TPN were similar among the groups ( P > 0. 05 ). Compared with group A, the concentration of NO in group C decreased more significantly at 1, 3 and 5 day especially ( P < 0. 01). Compared with group B, the concentration of NO in group C at 1, 3, 5 day also decreased (P < 0. 05). The concentration of NO was slightly higher in group C than in group B at 7 day, whereas the difference was not statistically significant (P > 0. 05). Compared with group A, the activity of DAO in group C decreased more significantly at 3, 5 , 7 day especially ( P < 0. 01) , and the differences be-tween group B and group C were statistically significant (P < 0. 05). Compared with group A and B, A-PACHE II score, incidence of MODS and 28 - day mortality decreased in group C (P <0. 05). Com-pared with group A, days in 1CU shortened slightly in group B and C, but the differences between the two groups were not statistically significant (P > 0. 05 ). Conclusion Astragalus combined with gluta-mine for strengthening immune nutrition therapy can protect intestinal mucosa injury induced by septic shock, and improve the prognosis of the patients, which is related to the inhibition of NO.