CAJ | 학술논문

　　目的观察麦滋林（L-谷氨酰胺呱仑酸钠）对重症急性胰腺炎（SAP）患者细胞免疫功能的影响。方法采用前瞻性研究方法，将本院收治的80例SAP患者按随机数字表法分为试验组和对照组，每组40例；同时选取20例健康志愿者作为健康对照组。两组患者均给予等氮等热量的全肠外营养，试验组静脉滴注（静滴）麦滋林0.4 g?kg-1?d-1（每日1次）共7 d，对照组静滴等量生理盐水。于治疗前1 d和治疗后7 d取外周静脉血，用四甲基偶氮唑盐（MTT）比色法测定T淋巴细胞增殖活性，用酶联免疫吸附试验（ELISA）测定白细胞介素（IL-2、IL-6）分泌水平。结果与健康对照组比较，两组治疗前外周血T淋巴细胞增殖活性〔吸光度（A）值〕、IL-2（ng/L）均显著降低，IL-6（ng/L）分泌量明显增加（P＜0.05或P＜0.01）；治疗7 d后，试验组SAP患者外周血T淋巴细胞增殖活性、IL-2均较本组治疗前显著增加（均P＜0.05），基本恢复至正常水平，而对照组则进行性下降（均P＜0.05）；且试验组明显高于对照组（T淋巴细胞增殖活性：1.08±0.27比0.43±0.25， IL-2：16.5±1.4比9.4±2.9，均P＜0.05）。两组IL-6均较治疗前显著降低（均P＜0.05），对照组基本恢复至健康对照组水平；且试验组明显低于对照组（18.8±4.5比22.3±3.1，P＜0.05）。结论 SAP患者存在细胞免疫功能障碍，表现为淋巴细胞增殖、IL-2降低、IL-6增高，早期应用麦滋林有助于改善SAP患者淋巴细胞免疫功能异常。
　　목적관찰맥자림（L-곡안선알고륜산납）대중증급성이선염（SAP）환자세포면역공능적영향。방법채용전첨성연구방법，장본원수치적80례SAP환자안수궤수자표법분위시험조화대조조，매조40례；동시선취20례건강지원자작위건강대조조。량조환자균급여등담등열량적전장외영양，시험조정맥적주（정적）맥자림0.4 g?kg-1?d-1（매일1차）공7 d，대조조정적등량생리염수。우치료전1 d화치료후7 d취외주정맥혈，용사갑기우담서염（MTT）비색법측정T림파세포증식활성，용매련면역흡부시험（ELISA）측정백세포개소（IL-2、IL-6）분비수평。결과여건강대조조비교，량조치료전외주혈T림파세포증식활성〔흡광도（A）치〕、IL-2（ng/L）균현저강저，IL-6（ng/L）분비량명현증가（P＜0.05혹P＜0.01）；치료7 d후，시험조SAP환자외주혈T림파세포증식활성、IL-2균교본조치료전현저증가（균P＜0.05），기본회복지정상수평，이대조조칙진행성하강（균P＜0.05）；차시험조명현고우대조조（T림파세포증식활성：1.08±0.27비0.43±0.25， IL-2：16.5±1.4비9.4±2.9，균P＜0.05）。량조IL-6균교치료전현저강저（균P＜0.05），대조조기본회복지건강대조조수평；차시험조명현저우대조조（18.8±4.5비22.3±3.1，P＜0.05）。결론 SAP환자존재세포면역공능장애，표현위림파세포증식、IL-2강저、IL-6증고，조기응용맥자림유조우개선SAP환자림파세포면역공능이상。
Objective To observe the effects of marzulene(L-glutamine and sodium gualenate)on cellular immune function in patients with severe acute pancreatitis(SAP). Methods A prospective study method was conducted in which 80 patients with SAP were divided into trial group and control group(each 40 cases)according to the table of random number methods,and in the mean time 20 healthy volunteers were enrolled in the healthy control group. Both SAP groups received standard total parenteral nutrition(TPN)with same quantities of heat and nitrogen, and the trial group additionally accepted intravenous drip of marzulene 0.4 g?kg-1?d-1(once a day)for 7 days,while the control group received the same amount of normal saline intravenous drip for 7 days. One day before treatment and on the 7th day after treatment,the peripheral venous blood samples were collected. The T-lymphocyte proliferation activity was tested by methyl thiazolyl tetrazolium(MTT)assay,and the interleukin-2(IL-2)and interleukin-6(IL-6) secretion levels were detected by enzyme-linked immunosorbent assay(ELISA). Results Compared to the healthy control group,the levels of T lymphocyte proliferation activity〔absorbance(A)value〕and IL-2(ng/L)were markedly decreased and IL-6(ng/L)secretion level was obviously increased before treatment in the two SAP groups(P<0.05 or P<0.01). Compared to prior treatment,the levels of T lymphocyte proliferation activity and IL-2 were significantly increased after 7 days of treatment in the trial group(both P<0.05),and basically restored to normal levels,while in the control group they were progressively decreased(both P<0.05),the levels in trial group being significantly higher than those of the control group(T lymphocyte proliferation activity:1.08±0.27 vs. 0.43±0.25,IL-2:16.5±1.4 vs. 9.4±2.9,both P<0.05),but compared to prior treatment,the level of IL-6 was significantly decreased in the two SAP groups(both P<0.05),the level of IL-6 in control group was recovered to the level of healthy control group,and the level in trial group being significantly lower than that of the control group(18.8±4.5 vs. 22.3±3.1, P<0.05). Conclusions The patients with SAP have cellular immune dysfunction,the manifestations being the suppression of T lymphocyte proliferation and IL-2 and increase of IL-6 release. Early application of marzulene can help to improve the immune function of lymphocytes in patients with SAP.