谷氨酰胺给药对 ICU 创伤患者固有免疫系统反应的影响。
Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit.
机构信息
Intensive Care Medicine Department, Son Dureta University Hospital, Andrea Doria 55, 07014, Palma de Mallorca, Spain.
出版信息
Crit Care. 2010;14(6):R233. doi: 10.1186/cc9388. Epub 2010 Dec 24.
INTRODUCTION
The use of glutamine as a dietary supplement is associated with a reduced risk of infection. We hypothesized that the underlying mechanism could be an increase in the expression and/or functionality of Toll-like receptors (TLR), key receptors sensing infections. The objective of this study was to evaluate whether glutamine supplementation alters the expression and functionality of TLR2 and TLR4 in circulating monocytes of trauma patients admitted to the intensive care unit (ICU).
METHODS
We designed a prospective, randomized and single-blind study. Twenty-three patients received parenteral nutrition (TPN) with a daily glutamine supplement of 0.35 g/kg. The control group (20 patients) received an isocaloric-isonitrogenated TPN. Blood samples were extracted before treatment, at 6 and 14 days. Expression of TLR2 and TLR4 was determined by flow cytometry. Monocytes were stimulated with TLR specific agonists and cytokines were measured in cell culture supernatants. Phagocytic ability of monocytes was also determined.
RESULTS
Basal characteristics were similar in both groups. Monocytes from patients treated with glutamine expressed the same TLR2 levels as controls before treatment (4.9 ± 3.5 rmfi vs. 4.3 ± 1.9 rmfi, respectively; P = 0.9), at Day 6 (3.8 ± 2.3 rmfi vs. 4.0 ± 1.7 rmfi, respectively; P = 0.7) and at Day 14 (4.1 ± 2.1 rfim vs. 4.6 ± 1.9 rmfi, respectively; P = 0.08). TLR4 levels were not significantly different between the groups before treatment: (1.1 ± 1 rmfi vs 0.9 ± 0.1 rmfi respectively; P = 0.9), at Day 6 (1.1 ± 1 rmfi vs. 0.7 ± 0.4 rmfi respectively; P = 0.1) and at Day 14 (1.4 ± 1.9 rmfi vs. 1.0 ± 0.6 rmfi respectively; P = 0.8). No differences in cell responses to TLR agonists were found between groups. TLR functionality studied by phagocytosis did not vary between groups.
CONCLUSIONS
In trauma patients in the intensive care unit, TPN supplemented with glutamine does not improve the expression or the functionality of TLRs in peripheral blood monocytes.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01250080.
简介
谷氨酰胺作为膳食补充剂的使用与感染风险降低有关。我们假设其潜在机制可能是增加 Toll 样受体 (TLR)的表达和/或功能，TLR 是感应感染的关键受体。本研究旨在评估谷氨酰胺补充是否会改变创伤后入住重症监护病房 (ICU)的患者循环单核细胞中 TLR2 和 TLR4 的表达和功能。
方法
我们设计了一项前瞻性、随机和单盲研究。23 名患者接受了含有 0.35 g/kg 日剂量谷氨酰胺的肠外营养 (TPN)。对照组（20 名患者）接受了等热量等氮的 TPN。在治疗前、第 6 天和第 14 天采集血样。通过流式细胞术测定 TLR2 和 TLR4 的表达。用 TLR 特异性激动剂刺激单核细胞，并测量细胞培养上清液中的细胞因子。还测定了单核细胞的吞噬能力。
结果
两组患者的基线特征相似。接受谷氨酰胺治疗的患者在治疗前的 TLR2 水平与对照组相同（分别为 4.9 ± 3.5 rmfi 和 4.3 ± 1.9 rmfi；P = 0.9），第 6 天（分别为 3.8 ± 2.3 rmfi 和 4.0 ± 1.7 rmfi；P = 0.7）和第 14 天（分别为 4.1 ± 2.1 rmfi 和 4.6 ± 1.9 rmfi；P = 0.08）。治疗前两组 TLR4 水平无显著差异：（分别为 1.1 ± 1 rmfi 和 0.9 ± 0.1 rmfi；P = 0.9），第 6 天（分别为 1.1 ± 1 rmfi 和 0.7 ± 0.4 rmfi；P = 0.1）和第 14 天（分别为 1.4 ± 1.9 rmfi 和 1.0 ± 0.6 rmfi；P = 0.8）。两组对 TLR 激动剂的细胞反应无差异。通过吞噬作用研究的 TLR 功能在两组之间没有差异。
结论
在重症监护病房的创伤患者中，TPN 补充谷氨酰胺不会改善外周血单核细胞中 TLR 的表达或功能。
试验注册
ClinicalTrials.gov 标识符：NCT01250080。
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