Department of Anaesthesiology and Intensive Care Unit, Eskisehir Osmangazi University Medical School, Eskişehir, Turkiye.
J Crit Care. 2010 Dec;25(4):661.e1-6. doi: 10.1016/j.jcrc.2010.03.011.
Glutamine is an important substrate for enterocyte and other rapidly proliferating cells. Low plasma and tissue levels present in glutamine in critically ill patients suggest that demand may exceed endogenous supply. Because commercially available amino acid solutions do not contain glutamine because of its instability in aqueous solution, conventional total parenteral nutrition (TPN) does not prevent stress-induced glutamine depletion. In this study, we administered intravenous glutamine-supplemented TPN to patients with systemic inflammatory response syndrome (SIRS) to investigate the effect of glutamine supplementation on immune states. This study is a prospective, randomized clinical trial. All patients received TPN given continuously for 6 days. Thirty patients with SIRS were allocated to either a glutamine group (l-glutamine 0.4g/[kg d]) (n = 15) or a control group (n = 15). Blood samples were collected on day 1 and day 6 after admission for C-reactive protein, immunoglobulin (Ig) M, IgG, IgA, C(3), C4, and lymphocyte analysis. The Acute Physiologic and Chronic Health Evaluation II score and the Simplified Acute Physiologic II (SAPS II) score were used to evaluate the patients after admission. Although there was a tendency for decreased T cytotoxic cells and natural killer cells in the control group, no significant difference was observed between the 2 groups. However, an increase in lymphocyte and lymphocyte subgroups in the glutamine group was observed; but there was no difference between the groups. A low SAPS II score was observed on the sixth day in the glutamine group, whereas no difference in SAPS II and Acute Physiologic and Chronic Health Evaluation II scores was observed between the 2 groups. There was no difference in IgM, IgG, IgA, C(3), and C4 levels and numbers of B-lymphocytes between the groups. Glutamine-added TPN significantly decreases leukocyte and natural killer cell count and therefore suppresses inflammation. Furthermore, total lymphocyte count, B- and T-lymphocytes, and their subgroups (helper T-lymphocytes, cytotoxic T-lymphocytes) are increased; although not statistically significant, these increases might be playing a role in improving the immune system.
谷氨酰胺是肠细胞和其他快速增殖细胞的重要底物。危重病患者血浆和组织中谷氨酰胺水平低表明需求可能超过内源性供应。由于商业上可获得的氨基酸溶液由于其在水溶液中的不稳定性而不含谷氨酰胺，因此常规的全胃肠外营养（TPN）不能防止应激引起的谷氨酰胺耗竭。在这项研究中，我们给全身炎症反应综合征（SIRS）患者静脉内补充谷氨酰胺的 TPN，以研究谷氨酰胺补充对免疫状态的影响。这是一项前瞻性、随机临床试验。所有患者均连续接受 TPN 治疗 6 天。将 30 例 SIRS 患者分为谷氨酰胺组（l-谷氨酰胺 0.4g/[kg·d]）（n=15）或对照组（n=15）。入院后第 1 天和第 6 天采集血样，用于检测 C 反应蛋白、免疫球蛋白（Ig）M、IgG、IgA、C3、C4 和淋巴细胞分析。入院后采用急性生理和慢性健康评估 II 评分（APACHE II）和简化急性生理评分 II（SAPS II）评分评估患者。虽然对照组 T 细胞毒性细胞和自然杀伤细胞有下降趋势，但两组间无显著差异。然而，谷氨酰胺组的淋巴细胞和淋巴细胞亚群增加；但两组间无差异。谷氨酰胺组入院第 6 天 SAPS II 评分较低，而两组间 SAPS II 和 APACHE II 评分无差异。两组间 IgM、IgG、IgA、C3 和 C4 水平以及 B 淋巴细胞数量无差异。添加谷氨酰胺的 TPN 可显著降低白细胞和自然杀伤细胞计数，从而抑制炎症。此外，总淋巴细胞计数、B 淋巴细胞和 T 淋巴细胞及其亚群（辅助性 T 淋巴细胞、细胞毒性 T 淋巴细胞）增加；尽管无统计学意义，但这些增加可能在改善免疫系统方面发挥作用。
