Pérez-Bárcena Jon, Regueiro Verónica, Marsé Pedro, Raurich Joan María, Rodríguez Alberto, Ibáñez Jordi, de Lorenzo Mateos Abelardo García, Bengoechea José Antonio
Intensive Care Unit, University Hospital Son Dureta, Palma de Mallorca, Spain.
Nutrition. 2008 Jun;24(6):522-7. doi: 10.1016/j.nut.2008.01.056. Epub 2008 Mar 26.
We evaluated the expression of Toll-like receptors 2 and 4 (TLR-2 and TLR-4) in circulating monocytes from peripheral blood of critical care patients treated with and without glutamine. Because no research has been published to date on the effect of glutamine on TLR receptors in critical patients, it was determined in an initial sample of 30 patients.
This was a prospective, randomized, single-blind study with 15 patients assigned to receive parenteral nutrition with a daily glutamine supplement of 0.35 g/kg. The control group received isocaloric-isonitrogenous parenteral nutrition. Blood samples were extracted before beginning the treatment and at 5 and 14 d. Expressions of CD14, TLR-2, and TLR-4 were determined by flow cytometry. Levels of TLRs were expressed as mean fluorescence intensity (mfi).
Basal characteristics were similar in both groups. The expressions of TLR-2 in the treatment group with glutamine were 4.67 +/- 3.82 mfi before treatment, 3.91 +/- 2.04 mfi at 5 d, and 4.28 +/- 2.47 mfi at 14 d. The expressions of TLR-2 in the control group were 5.49 +/- 3.20 mfi before treatment, 4.48 +/- 2.15 mfi at 5 d, and 4.36 +/- 2.36 mfi at 14 d. The expressions of TLR-4 in the treatment group were 1.65 +/- 1.89 mfi before treatment, 1.23 +/- 1.10 mfi at 5 d, and 1.77 +/- 1.97 at 14 d. The expressions of TLR-4 in the control group were 1.51 +/- 1.76 mfi before treatment, 1.36 +/- 0.99 mfi at 5 d, and 1.26 +/- 0.59 mfi at 14 d. Infections were detected in 11 patients who received glutamine and 13 control patients (P = 0.51).
In critical care patients, parenteral nutrition supplemented with glutamine does not increase the expression of TLR-2 or TLR-4 in peripheral blood monocytes.
我们评估了接受谷氨酰胺治疗和未接受谷氨酰胺治疗的重症监护患者外周血循环单核细胞中Toll样受体2和4（TLR-2和TLR-4）的表达。由于迄今为止尚未发表关于谷氨酰胺对重症患者TLR受体影响的研究，因此在30例患者的初始样本中进行了此项研究。
这是一项前瞻性、随机、单盲研究，15例患者被分配接受每日补充0.35 g/kg谷氨酰胺的肠外营养。对照组接受等热量-等氮的肠外营养。在治疗开始前、第5天和第14天采集血样。通过流式细胞术测定CD14、TLR-2和TLR-4的表达。TLR水平以平均荧光强度（mfi）表示。
两组的基础特征相似。谷氨酰胺治疗组中TLR-2的表达在治疗前为4.67±3.82 mfi，第5天为3.91±2.04 mfi，第14天为4.28±2.47 mfi。对照组中TLR-2的表达在治疗前为5.49±3.20 mfi，第5天为4.48±2.15 mfi，第14天为4.36±2.36 mfi。治疗组中TLR-4的表达在治疗前为1.65±1.89 mfi，第5天为1.23±1.10 mfi，第14天为1.77±1.97 mfi。对照组中TLR-4的表达在治疗前为1.51±1.76 mfi，第5天为1.36±0.99 mfi，第14天为1.26±0.59 mfi。在接受谷氨酰胺的11例患者和13例对照患者中检测到感染（P = 0.51）。
在重症监护患者中，补充谷氨酰胺的肠外营养不会增加外周血单核细胞中TLR-2或TLR-4的表达。
