CAJ | 학술논문

目的：探讨谷氨酰胺（Gln）对脓毒症休克患者血清高迁移率族蛋白B1（HMGB1）的影响，以期阐明Gln在治疗脓毒症休克患者的作用机制。方法选取2009年5月至2012年7月该院IC U病房收治的脓毒症休克患者72例为研究对象，随机分为对照组和实验组，所有患者均采用常规的液体复苏、抗菌药物治疗以及使用呼吸机等措施，待体征稳定后，对照组患者给予低热量肠外营养支持，实验组在给予低热量肠外营养支持的同时联合静脉注射Gln进行治疗。所有患者于治疗前及治疗后第1、3、7天4个不同时间点测量急性生理与慢性健康评分（APACHE-Ⅱ）、血清Gln浓度、血清HMGB1浓度，分析Gln对脓毒症休克患者的治疗效果及 HMGB1的影响。结果随着患者发病时间的延长，对照组患者血清Gln浓度从治疗第3天（409．63±158．74）μmol/L开始显著下降；而实验组从治疗第1天（503．92±167．66）μmol/L开始逐渐上升，与对照组比较差异有统计学意义（P＜0．05）；对照组患者治疗前、后其血清内HMGB1浓度未出现变化；实验组患者血清HMGB1浓度从治疗后1 d（29．24±23．91）ng/mL逐渐下降，各个时间点处与对照组比较差异有统计学意义（P＜0．05）。同时，通过与血清中Gln浓度的变化对照研究发现，实验组血清 HMGB1浓度在治疗前、后[（34．23±23．69）ng/mL、（29．24±23．91）ng/mL]的变化与Gln浓度[（470．05±152．40）μmol/L、（503．92±167．66）μmol/L]升高具有相关性。结论脓毒症休克后早期Gln的应用有效增加血浆Gln浓度，同时降低了血清HMGB1浓度，改善脓毒症休克患者的预后情况。
목적：탐토곡안선알（Gln）대농독증휴극환자혈청고천이솔족단백B1（HMGB1）적영향，이기천명Gln재치료농독증휴극환자적작용궤제。방법선취2009년5월지2012년7월해원IC U병방수치적농독증휴극환자72례위연구대상，수궤분위대조조화실험조，소유환자균채용상규적액체복소、항균약물치료이급사용호흡궤등조시，대체정은정후，대조조환자급여저열량장외영양지지，실험조재급여저열량장외영양지지적동시연합정맥주사Gln진행치료。소유환자우치료전급치료후제1、3、7천4개불동시간점측량급성생리여만성건강평분（APACHE-Ⅱ）、혈청Gln농도、혈청HMGB1농도，분석Gln대농독증휴극환자적치료효과급 HMGB1적영향。결과수착환자발병시간적연장，대조조환자혈청Gln농도종치료제3천（409．63±158．74）μmol/L개시현저하강；이실험조종치료제1천（503．92±167．66）μmol/L개시축점상승，여대조조비교차이유통계학의의（P＜0．05）；대조조환자치료전、후기혈청내HMGB1농도미출현변화；실험조환자혈청HMGB1농도종치료후1 d（29．24±23．91）ng/mL축점하강，각개시간점처여대조조비교차이유통계학의의（P＜0．05）。동시，통과여혈청중Gln농도적변화대조연구발현，실험조혈청 HMGB1농도재치료전、후[（34．23±23．69）ng/mL、（29．24±23．91）ng/mL]적변화여Gln농도[（470．05±152．40）μmol/L、（503．92±167．66）μmol/L]승고구유상관성。결론농독증휴극후조기Gln적응용유효증가혈장Gln농도，동시강저료혈청HMGB1농도，개선농독증휴극환자적예후정황。
Objective To evaluate the effection of high mobility group box1protein on septic shock patients with the treatment of glutamine and to demonstrate the mechanism of the treatment of glutamine in patients with septic shock .Methods Seventy-two septic shock cases were selected in ICU of the hospital in May 2009 to July 2012 ,and then two groups were randomly divided ,just named control group and experimental group .After the traditional treatment ,such as fluid resuscitation ,antibiotic therapy and the use of breathing machine ,the control group received low-calorie parenteral nutrition and the experimental group received low-calorie parenteral nutrition combined with intravenous injection of glutamine .APACHEⅡscore ,the concentrations of serum glutamine and HMGB1 were detected at 4 different time points before treatment and the 1st ,3rd ,7th day after the treatment ,to analyze the effec-tion of the change of serum HMBD1 on septic shock patients with the treatment of glutamine .Results The serum glutamine and HMGB1 concentrations were detected with RP-HPLC and ELISA respectively .The result showed that with the intra-group com-parison ,APACHEⅡscores of both two groups after the treatment were lower than that before treatment ,and compare with the control ,the APACHEⅡscore of the experimental group was significantly lower .With disease duration increased ,the concentration of serum glutamine(409 .63 ± 158 .74)μmol/L in the control group was significantly decreased from 3 days after treatment ,that in the experimental group from 1 day (503 .92 ± 167 .66)μmol/L were gradually increased .the HMGB1 concentration in the control group did not appear change ,but that in the experimental group from 1 day (29 .24 ± 23 .91)ng/mL was decreased .Meanwhile ,the level of serum HMGB1[(34 .23 ± 23 .69)ng/mL ,(29 .24 ± 23 .91)ng/mL] concentration decreased synchronized with the changes in concentration of serum glutamine[(470 .05 ± 152 .40)μmol/L ,(503 .92 ± 167 .66)μmol/L] .Conclusion the application of Gluta-mine in treatment of septic shock existed positive significance for patients ,which can effectively increased the concentration of serum glutamine and reduced the concentration of HMGB1 ,to improve the prognosis of patients with septic shock .