摘要
目的:探讨谷氨酰胺早期肠内营养对改善急性腹部损伤患者小肠黏膜屏障功能的作用机制。方法:随机选取急性腹部损伤患者45例,根据谷氨酰胺的剂量分为生理量组(0. 3 g/kg·d) 20例,大剂量组(0. 6 g/kg·d) 25例,连续肠内营养5 d,检测肠粘膜屏障功能评价指标包括:尿中脂肪酸结合蛋白(IFABP)、血清肿瘤坏死因子-a(TNF-a)、二胺氧化酶(DAO)活性和免疫蛋白:IgG、IgM和分泌型免疫球蛋白A(sIgA)水平。结果:生理量组尿IFABP为(265. 33±25. 94) ng/m L,而大剂量组为(113. 66±14. 26) ng/m L,组间比较差异有统计学意义(P <0. 05);补充谷氨酰胺后,大剂量组血清肿瘤坏死因子-α(TNF-α)水平降低,而生理量组TNF-a升高,两组比较差异有统计学意义(P <0. 05),两组二胺氧化酶(DAO)活性比较差异无统计学意义(P> 0. 05);大剂量组免疫调节功能改善,免疫球蛋白IgG、IgM和s IgA均高于生理量组(P <0. 05)。结论:急性腹部损伤患者早期给予谷氨酰胺肠内营养,可以通过减轻肠缺血、防止肠粘膜萎缩、调节免疫功能和抑制肠内细菌移位而改善小肠黏膜屏障功能。
Objective： To investigate the mechanism of early enteral nutrition of glutamine on improving intestinal mucosal barrier function in patients with acute abdominal injury. Methods： 45 patients with acute abdominal injury were randomly selected, and divided into physiological dose group （0.3g/kg.d, 20 cases） and large dose group （0.6/kg.d, 25 cases） according to the dose of glutamine. The two groups had continuous enteral nutrition for 5 days, and intestinal mucosal barrier function of them was detected. Urinary fatty acid binding protein （IFABP）, serum tumor necrosis factor -a （TNF-a）, diamineoxidase （DAO） activity, and levels of immune protein IgG and IgM and secretory immunoglobulin A （sIgA） were included in the evaluation indexes. Results： The urinary IFABP of the physiological dose group was （265.33±25.94） ng/ml, and that of the large dose group was （113.66±14.26） ng/ml, and the urinary IFABP of the two groups had significant difference （ P 〈0.05）. After glutamine supplementation, serum TNF-a of the large dose group was significantly decreased, while the serum TNF-a of the physiological dose group was increased significantly, and there was significant difference between the two groups （ P 〈0.05）; DAO activity of the two groups had no statistically significant difference （P〉0.05）; Immune function of the large dose group was improved, and the levels of immunoglobulin IgG, IgM and sIgA of the large dose group were significantly higher than those of the physiological dose group （ P 〈0.05）. Conclusion： Early enteral glutamine supplementation in acute abdominal injury can improve intestinal mucosal barrier function by reducing intestinal ischemia, preventing intestinal mucosal atrophy, regulating immune function and inhibiting bacterial translocation in the intestine.
作者
邹向竞
杨新霞
ZOU Xiangjing;YANG Xinxia(The Second People＇s Hospital in Huadu District of Guangzhou,Guangzhou 510850,China)
出处
《包头医学院学报》
CAS
2018年第10期32-34,共3页
Journal of Baotou Medical College
关键词
谷氨酰胺
急性腹部损伤
小肠黏膜屏障功能
Glutamine
Acute abdominal injury
Intestinal nmcosal barrier function
