Hamani Djamel, Charrueau Christine, Butel Marie-José, Besson Valérie, Belabed Linda, Nicolis Ioannis, Le Plénier Servane, Marchand-Leroux Catherine, Chaumeil Jean-Claude, Cynober Luc, Moinard Christophe
Université Paris Descartes, Faculté de Pharmacie, Laboratoire de Biologie de la Nutrition EA2498, 4 avenue de l'Observatoire, 75270, Paris Cedex 06, France.
Intensive Care Med. 2007 Jun;33(6):1076-84. doi: 10.1007/s00134-007-0624-0. Epub 2007 Apr 11.
The benefit of immune-enhancing diets (IEDs) in the intensive care unit remains controversial. Considering their complexity, the role of each component, in particular arginine (Arg), in their properties is largely unknown. The aim of this study was to determine the role of arginine in the immunomodulatory effects of an IED (Crucial) in head-injured rats.
Thirty-four rats were randomized into five groups: AL (ad libitum), HI (head-injured), HI-STD (HI + standard enteral nutrition, EN), HI-STD-Arg (HI + standard EN + Arg in equimolar concentration to Arg in IED), and HI-IED (HI + IED). These isocaloric and isonitrogenous diets were administered over 4 days. After death, the thymus was removed and weighed. The density of CD25, CD4 and CD8 on lymphocytes from blood and from Peyer patches was evaluated. Mesenteric lymph nodes, liver and spleen were cultured for analysis of enterobacterial translocation and dissemination.
HI induced an atrophy of the thymus which was not corrected by the standard diet (HI 0.27 +/- 0.03, HI-STD 0.35 +/- 0.03 vs. AL 0.49 +/- 0.02 g; p < 0.05). However, the standard diet supplemented with arginine limited the thymic atrophy and the IED restored thymus weight. CD25 density and interleukin-2 production were increased only in the HI-STD-Arg and HI-IED groups (p < 0.05). Head injury induced enterobacterial translocation and dissemination which were blunted only in the HI-STD-Arg group (p < 0.05).
In this rat HI model, arginine appears to be safe, contributes to a large extent to the immunomodulatory effects of the IED, and seems to limit enterobacterial translocation and dissemination more efficiently alone than in an IED.
免疫增强饮食（IEDs）在重症监护病房中的益处仍存在争议。鉴于其复杂性，各成分尤其是精氨酸（Arg）在其特性中的作用在很大程度上尚不清楚。本研究的目的是确定精氨酸在IED（Crucial）对颅脑损伤大鼠的免疫调节作用中的作用。
34只大鼠随机分为五组：AL（自由进食）、HI（颅脑损伤）、HI-STD（HI+标准肠内营养，EN）、HI-STD-Arg（HI+标准EN+与IED中精氨酸等摩尔浓度的精氨酸）和HI-IED（HI+IED）。这些等热量和等氮的饮食持续给予4天。处死大鼠后，取出胸腺并称重。评估血液和派尔集合淋巴结中淋巴细胞上CD25、CD4和CD8的密度。培养肠系膜淋巴结、肝脏和脾脏以分析肠道细菌移位和播散情况。
HI导致胸腺萎缩，标准饮食未使其得到纠正（HI组为0.27±0.03，HI-STD组为0.35±0.03，而AL组为0.49±0.02 g；p<0.05）。然而，补充精氨酸的标准饮食限制了胸腺萎缩，且IED恢复了胸腺重量。仅在HI-STD-Arg组和HI-IED组中CD25密度和白细胞介素-2产生增加（p<0.05）。颅脑损伤诱导了肠道细菌移位和播散，仅在HI-STD-Arg组中受到抑制（p<0.05）。
在这个大鼠颅脑损伤模型中，精氨酸似乎是安全的，在很大程度上有助于IED的免疫调节作用，并且单独使用时似乎比在IED中更有效地限制肠道细菌移位和播散。
