Peng Xi, Yan Hong, You Zhongyi, Wang Pei, Wang Shiliang
Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing 400038, PR China.
Burns. 2006 Aug;32(5):589-93. doi: 10.1016/j.burns.2005.11.020. Epub 2006 May 24.
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.
谷氨酰胺是免疫细胞的重要能量来源。它是细胞增殖所必需的营养素，当以适当浓度存在时，可作为淋巴细胞、巨噬细胞和肠上皮细胞的特定燃料。本临床研究的目的是观察补充谷氨酰胺颗粒的肠内营养对严重烧伤患者免疫功能的影响。48例符合方案要求的严重烧伤患者（烧伤总面积30 - 75%，全层烧伤面积20 - 58%）参加了这项双盲随机对照临床试验。患者被随机分为两组：烧伤对照组（B组，23例患者）和谷氨酰胺治疗组（Gln组，25例患者）。两组摄入的氮量和热量相等，Gln组和B组患者分别通过口服或管饲给予0.5 g/kgd的谷氨酰胺颗粒或安慰剂（甘氨酸），持续14天。测定血浆谷氨酰胺水平以及免疫功能的几个指标，包括淋巴细胞转化率、中性粒细胞吞噬指数（NPI）、CD4/CD8比值、免疫球蛋白含量、补体C3、C4和IL - 2水平。此外，观察烧伤创面愈合率并记录住院时间。结果显示，严重烧伤后血浆谷氨酰胺显著降低，免疫功能受损，细胞免疫功能指标与正常对照组相比明显下降。服用谷氨酰胺颗粒14天后，Gln组血浆谷氨酰胺浓度显著高于B组（607.86±147.25 μmol/L对447.63±132.38 μmol/L，P<0.01）。另一方面，Gln组的细胞免疫功能得到改善，如淋巴细胞转化率、NPI、CD4/CD8比值和IL - 2水平与B组相比（P<0.05 - 0.01）。然而，对于体液免疫功能，如IgG、IgM、C3、C4的浓度，与B组相比未见明显变化（P>0.05）。此外，Gln组的创面愈合更好，住院天数减少（46.59±12.98天对55.68±17.36天，P<0.05）。这些表明严重烧伤后存在免疫功能损害；口服或管饲补充谷氨酰胺颗粒可减轻免疫抑制程度，改善免疫功能尤其是细胞免疫功能，促进创面愈合并缩短住院时间。
