肠内营养增加谷氨酰胺对重型脑外伤病人的人类白细胞抗原DR表达的影响

目的]探讨在重度脑外伤病人住院后的前15 d中,在肠内营养中增加谷氨酰胺,观察其对单核细胞的HLA DR的表达。方法]2002年1月至2004年6月,在山东省千佛山医院,将55 例严重脑外伤病人随机分2 组,实验组28例增加谷氨酰胺的肠内营养,对照组27例给予同等热量、同等氮量的肠内营养液,选出年龄相当的健康志愿者43 人为健康对照组。在外伤后第1、5、9、14 d测定单核细胞的HLA DR的表达,测定血浆谷氨酰胺含量。结果]在第3 天至5天,血浆中谷氨酰胺含量,实验组与对照组低于健康对照组,实验组高于对照组;HLA DR的表达,外伤第1 天实验组与对照组明显低于健康对照组,第5天、第9天和第14天实验组高于对照组。结论]增加谷氨酰胺的肠内营养饮食能增加严重脑外伤病人单核细胞的HLA DR的表达,从而提高病人的细胞免疫功能。

Glutamine-Enriched Enteral Nutrition Increases Hla-Dr Expression on Monocytes of Patients With Severe Brain Injury

Objective]The aim of this study was to investigate the effect of glutamine enriched enteral nutrition (EN) on human leukocyte antigen (HLA) DR expression on monocytes in patients with severe brain injury Methods]55 patients with severe brain injury were studied in a randomized, controlled trial Trauma patients received either a glutamine enriched EN (experimental group, n = 28) or an isocaloric, isonitrogenous control EN (control group, n = 27) and were compared with a group of age matched healthy volunteers (healthy control group, n = 43) On 1, 5, 9 and 14 d after trauma, expressions of HLA DR were determined and plasma glutamine levels were measured Results]Plasma glutamine was lower in both trauma patient groups compared with healthy volunteers and from 3 d to 5 d; glutamine was higher in the glutamine group than in the control group On 1 d, HLA DR expression was much lower in both trauma patient groups than in healthy volunteers HLA DR expression was greater on 5, 9 d and 14 in the glutamine group than in the control group Conclusions]This study showed that glutamine enriched enteral nutrition was associated with a higher HLA DR expression on monocytes of patients with severe brain injury Increased HLA DR expression may improve cellular immune function in patients with severe brain injury