谷氨酰胺对脓毒症患者肠粘膜屏障功能和免疫功能的影响

目的:研究谷氨酰胺对脓毒症患者肠道黏膜屏障功能和免疫功能的影响。方法:将2012年10月至2013年10本院收治的40例脓毒症患者随机分为治疗组和对照组,每组20例。两组患者均给予常规对症治疗,治疗组在此基础上加用谷氨酰胺治疗,对照组接受安慰剂治疗。采用分光光度法监测其血清D-乳酸水平,高效液相色谱法监测尿乳果糖/甘露醇(L/M)值。对比两组肠道黏膜屏障功能和免疫功能指标及ARDS、MODS发生率。结果:治疗后,治疗组ARDS和MODS发生率分别为24.1%,17.2%,均低于对照组的38.9%,33.3%,两组比较差异均有统计学意义(P0.05);治疗14 d后,治疗组D-乳酸及尿L/M水平较对照组明显降低,血清Ig G、Ig M、CD4+和CD4+/CD8+水平均增高,两组比较差异均有统计学意义(P0.05)。结论:谷氨酰胺治疗脓毒性患能明显改善肠道黏膜屏障功能,促进患者免疫功能和营养状态的提高,同时还能够降低患者肠道细菌、内毒素移位。

Effect of Glutamine on Intestinal Mucosal Barrier Function and Immune Function in Septic Patients

Objective:To study the effect of glutamine on intestinal mucosal barrier function and immune function in septic patients.Methods:40 cases of sepsis patients who were treated in our hospital from October 2012 to October 2013 were randomly divided into treatment group and control group, and 20 cases were in each group. Two groups were given conventional symptomatic treatment, the treatment group received glutamine treatment and the control group received a placebo. The serumD-lactic acid levels was detected by spectrophotometry,and urinary lactulose / mannitol (L/M) value was detected by High performance liquid chromatography. Indexes of intestinal mucosal barrier function, immune function and the incidence of ARDS, MODS were compared between two groups.Results:After treatment, the incidence of ARDS, MODS of treatment group were 24.1%, 17.2%, lower than those of the control group (38.9%, 33.3%), the difference was statistically significant (P<0.05); At 14 days after treatment, the D-lactic acid level and the urinary L/M level in treatment group were significantly lower than those of the control group,and serum IgG, IgM, CD4+ and CD4+/CD8+ increased significantly.Conclusion:Glutaminecan significantly improve the intestinal mucosal barrier function, and promote the immune function and nutritional status in treatment of sepsis patients, it can also reduce the translocation of intestinal bacteria and endotoxin.