背景:营养支持已成为慢性阻塞性肺疾病的重要治疗措施之一,然而部分营养不良的慢性阻塞性肺疾病患者存在营养支持"无反应"的现象,可能与其炎症反应过度、能量消耗增加有关.近年来免疫营养和代谢支持已成为近代营养支持范畴中的研究重点.目的:探讨营养底物谷氨酰胺对慢性阻塞性肺疾病免疫调理和代谢支持的作用.设计:随机对照实验.单位:上海第二医科大学附属新华医院.对象:选择2002-02/2002-07慢性阻塞性肺疾病急性发作患者44例,均为男性.随机分为2组:治疗组14例和对照组18例,年龄(75±9)岁.干预:对照给予单纯营养支持,治疗组给予谷氨酰胺治疗.全部患者由营养师指导按1.5×静息能量消耗的总热量饮食,其中蛋白质占热量的20%,脂肪占热量的30%,碳水化合物占热量的50%,治疗组减少蛋白质30 g,以L-谷氨酰胺30 g替代,10 g/次,3次/d,口服.10 d后检测营养指标(包括体质量、体质量指数、肱三头肌皮褶厚度、肌酐升高指数、血清白蛋白、白蛋白、转铁蛋白、脂群等)和免疫指标(包括免疫球蛋白、补体、T细胞亚群、白介素2、肿瘤坏死因子-α,C反应蛋白等)及静息能量的消耗.主要观察指标:观察治疗前后两组患者营养和免疫指标的变化.结果:32例患者均进入结果分析.[1]肱三头肌皮褶厚度:治疗组组内比较治疗前明显低于治疗后[(6.3±1.8),(8.7±1.6)mm,(P＜0.05)],两组治疗后比较对照组明显低于治疗组(7.3±1.3,8.7±1.6)mm,(P＜0.05)].[2]前白蛋白:治疗组组内比较治疗前明显低于治疗后[(0.15±0.04,0.23±0.05)g/L,(P＜0.01)],两组治疗后比较治疗组高于对照组[(0.23±0.05,0.22±0.08)g/L,(P＜0.05)].[3]T细胞亚群:CD3治疗组组内比较治疗前明显低于治疗后[(59±10,72±10),(P＜0.01)],两组治疗后比较对照组明显低于治疗组[(62±9,72±10),(P＜0.01)][4]肿瘤坏死因子-α:治疗组组内比较治疗前明显高于治疗后[(72±7,56±5)ng/mL,(尸＜0.05)],两组治疗后比较治疗组明显低于对照组[(56±5)vs(67±11)ng/mL,(P＜0.05)].[5]免疫球蛋白:IgG治疗组组内比较治疗后高于治疗前[(13±3,12±3)g/L,(P＜0.05)],两组治疗后比较治疗组高于对照组[(13±3,12±4)g/L,(P＜0.05)].结论:在营养支持时给予谷氨酰胺强化治疗,不仅能改善慢性阻塞性肺疾病患者的细胞免疫功能、抑制炎症反应过度表达、降低机体的能量代谢消耗,还能更进一步增加营养支持的疗效.
揹景:營養支持已成為慢性阻塞性肺疾病的重要治療措施之一,然而部分營養不良的慢性阻塞性肺疾病患者存在營養支持"無反應"的現象,可能與其炎癥反應過度、能量消耗增加有關.近年來免疫營養和代謝支持已成為近代營養支持範疇中的研究重點.目的:探討營養底物穀氨酰胺對慢性阻塞性肺疾病免疫調理和代謝支持的作用.設計:隨機對照實驗.單位:上海第二醫科大學附屬新華醫院.對象:選擇2002-02/2002-07慢性阻塞性肺疾病急性髮作患者44例,均為男性.隨機分為2組:治療組14例和對照組18例,年齡(75±9)歲.榦預:對照給予單純營養支持,治療組給予穀氨酰胺治療.全部患者由營養師指導按1.5×靜息能量消耗的總熱量飲食,其中蛋白質佔熱量的20%,脂肪佔熱量的30%,碳水化閤物佔熱量的50%,治療組減少蛋白質30 g,以L-穀氨酰胺30 g替代,10 g/次,3次/d,口服.10 d後檢測營養指標(包括體質量、體質量指數、肱三頭肌皮褶厚度、肌酐升高指數、血清白蛋白、白蛋白、轉鐵蛋白、脂群等)和免疫指標(包括免疫毬蛋白、補體、T細胞亞群、白介素2、腫瘤壞死因子-α,C反應蛋白等)及靜息能量的消耗.主要觀察指標:觀察治療前後兩組患者營養和免疫指標的變化.結果:32例患者均進入結果分析.[1]肱三頭肌皮褶厚度:治療組組內比較治療前明顯低于治療後[(6.3±1.8),(8.7±1.6)mm,(P＜0.05)],兩組治療後比較對照組明顯低于治療組(7.3±1.3,8.7±1.6)mm,(P＜0.05)].[2]前白蛋白:治療組組內比較治療前明顯低于治療後[(0.15±0.04,0.23±0.05)g/L,(P＜0.01)],兩組治療後比較治療組高于對照組[(0.23±0.05,0.22±0.08)g/L,(P＜0.05)].[3]T細胞亞群:CD3治療組組內比較治療前明顯低于治療後[(59±10,72±10),(P＜0.01)],兩組治療後比較對照組明顯低于治療組[(62±9,72±10),(P＜0.01)][4]腫瘤壞死因子-α:治療組組內比較治療前明顯高于治療後[(72±7,56±5)ng/mL,(尸＜0.05)],兩組治療後比較治療組明顯低于對照組[(56±5)vs(67±11)ng/mL,(P＜0.05)].[5]免疫毬蛋白:IgG治療組組內比較治療後高于治療前[(13±3,12±3)g/L,(P＜0.05)],兩組治療後比較治療組高于對照組[(13±3,12±4)g/L,(P＜0.05)].結論:在營養支持時給予穀氨酰胺彊化治療,不僅能改善慢性阻塞性肺疾病患者的細胞免疫功能、抑製炎癥反應過度錶達、降低機體的能量代謝消耗,還能更進一步增加營養支持的療效.
배경:영양지지이성위만성조새성폐질병적중요치료조시지일,연이부분영양불량적만성조새성폐질병환자존재영양지지"무반응"적현상,가능여기염증반응과도、능량소모증가유관.근년래면역영양화대사지지이성위근대영양지지범주중적연구중점.목적:탐토영양저물곡안선알대만성조새성폐질병면역조리화대사지지적작용.설계:수궤대조실험.단위:상해제이의과대학부속신화의원.대상:선택2002-02/2002-07만성조새성폐질병급성발작환자44례,균위남성.수궤분위2조:치료조14례화대조조18례,년령(75±9)세.간예:대조급여단순영양지지,치료조급여곡안선알치료.전부환자유영양사지도안1.5×정식능량소모적총열량음식,기중단백질점열량적20%,지방점열량적30%,탄수화합물점열량적50%,치료조감소단백질30 g,이L-곡안선알30 g체대,10 g/차,3차/d,구복.10 d후검측영양지표(포괄체질량、체질량지수、굉삼두기피습후도、기항승고지수、혈청백단백、백단백、전철단백、지군등)화면역지표(포괄면역구단백、보체、T세포아군、백개소2、종류배사인자-α,C반응단백등)급정식능량적소모.주요관찰지표:관찰치료전후량조환자영양화면역지표적변화.결과:32례환자균진입결과분석.[1]굉삼두기피습후도:치료조조내비교치료전명현저우치료후[(6.3±1.8),(8.7±1.6)mm,(P＜0.05)],량조치료후비교대조조명현저우치료조(7.3±1.3,8.7±1.6)mm,(P＜0.05)].[2]전백단백:치료조조내비교치료전명현저우치료후[(0.15±0.04,0.23±0.05)g/L,(P＜0.01)],량조치료후비교치료조고우대조조[(0.23±0.05,0.22±0.08)g/L,(P＜0.05)].[3]T세포아군:CD3치료조조내비교치료전명현저우치료후[(59±10,72±10),(P＜0.01)],량조치료후비교대조조명현저우치료조[(62±9,72±10),(P＜0.01)][4]종류배사인자-α:치료조조내비교치료전명현고우치료후[(72±7,56±5)ng/mL,(시＜0.05)],량조치료후비교치료조명현저우대조조[(56±5)vs(67±11)ng/mL,(P＜0.05)].[5]면역구단백:IgG치료조조내비교치료후고우치료전[(13±3,12±3)g/L,(P＜0.05)],량조치료후비교치료조고우대조조[(13±3,12±4)g/L,(P＜0.05)].결론:재영양지지시급여곡안선알강화치료,불부능개선만성조새성폐질병환자적세포면역공능、억제염증반응과도표체、강저궤체적능량대사소모,환능경진일보증가영양지지적료효.
BACKGROUND: Nutritional support has become one of the most important therapeutic measures for malnutrition patients with chronic obstructive pulmonary disease (COPD), but some of the patients may fail to respond to nutritional treatment, which might be attributed to excessive inflammatory reaction that increases energy expenditure. Current nutritional support strategies have primarily focused on immunonutrition and metabolic support.OBJECTIVE: To study the effect of glutamine (Gln) on immunomodulation and metabolic support for patients with COPD.DESIGN: Randomized controlled trial.SETTING: Xinhua Hospital Affiliated to Shanghai Second Medical UniversityPARTICIPANTS: Totally 44 male patients with acute episode of COPD aged (75±9) years admitted between February and July 2002 were recruited in this study and randomly divided into treatment group (n=14) and control group (n=18).INTERVENTIONS: Only nutritional support was given in the control group while the treatment group received also glutamine treatment. All the patients received nutritional support with the total calorie intake of 1.5times of resting energy expenditure and dietary counseling for a regular diet (20% protein, 30% fat, and 50% carbohydrate) provided by a nutritionist. In the treatment group, the protein intake was reduced by 30 g and replaced by 30 g of Gln given at 10 g each time for three times a day via oral therapy. The nutritional indices were measured including body mass,body mass index, triceps skinfold thickness (TSF), creatinine-height index (CHI), prealbumin (PAlb), albumin (ALB), transferrin (TRF), fat mass (FM)]and the immune indices examined including immunoglobulin, complements, T cell subsets, interleukin (IL)-2, tumor necrosis factor-α (TNF-α),and C-reactive protein etc with also measurement of resting energy expenditure.MAIN OUTCOME MEASURES: Changes in nutritional and immune indices of patients before and after treatment.RESULTS: Thirty-two patients all entered the result analysis. [1] TSF: In the treatment group, TSF increased significantly from (6.3±1.8) mm before treatment to (8.7±1.6) mm after treatment (P ＜ 0.05), which was significantly greater than that in the control group after treatment [(7.3±1.3) mm,P ＜ 0.05]. [2]Palb: Palb was significantly increased after treatment in the treatment group from (0.15±0.04) to (0.23±0.05) g/L (P ＜ 0.01), which was significantly higher than that in the control group [(0.22±0.08) g/L, P＜ 0.05)]. [3]T cell subsets: in the treatment group, CD3 in creased significantly from 59±10 before treatment to 72±10 after treatment (P ＜ 0.01), a level significantly higher than that in the control group after treatment (62±9, P ＞ 0.01). [4] TNF-α :TNF-α in the treatment group before treatment was significantly higher than that after treatment [(72±7) vs (56±5) ng/mL,P ＜ 0.05)], and after treatment TNF-α in the treatment group was significantly lower than that in the control group [(67±11) ng/mL, (P ＜ 0.05)]. [5]Immunoglobin: IgG increased slightly after treatment in the treatment group[(12±3) vs (13±3) g/L, P ＜ 0.05)], which was higher than that in the control group [(12±4) g/L], but the difference was not significant (P ＜ 0.05).CONCLUSION: Gln treatment in addition to nutritional support can promote cellular immune function, depress excessive inflammatory reaction and lower energy expenditure in patients with COPD, and such strategy also further enhance the effect of nutritional support.
