丙氨酰谷氨酰胺对急性肺损伤患者的保护作用及其机制初探

摘要

目的 观察丙氨酰谷氨酰胺(Ala-Gln)对急性肺损伤(ALI)患者的保护作用及其机制.方法 110例ALI患者随机分为对照组(50例)和Ala-Gln组(60例).对照组给予常规治疗,Ala-Gln组在常规治疗的基础上,加用Ala-Gln,疗程7天,分别观察两组间治疗前后血清谷氨酰胺(Gln)、热休克蛋白70(HSP70)水平、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)及机械通气时间的差异.结果 Ala-Gln组治疗后血清HSP70、Gln水平明显增高,与治疗前比较差异有统计学意义,HSP70 (1.99±0.66) μg/L vs (1.34±0.68) μg/L( P＜0.01)；Gln (386.15±68.60)μg/L vs (304.72±73.70) μg/L(P＜0.01).与对照组治疗后比较差异亦有统计学意义,Gln (386.15±68.60) μg/L vs (303.74±78.08) μg/L( P＜0.01);HSP70 (1.99±0.66) μg/L vs(1.35±0.48)μg/L(P＜0.01).Ala-Gln组治疗前后Gln浓度比与HSP70浓度比呈明显正相关(r=0.809,P＜0.01),对照组治疗前后血清Gln、HSP70水平差异无统计学意义,对照组治疗前后Gln浓度比与HSP70浓度比无明显相关性(r=0.147,P＞0.05).Ala-Gln组机械通气时间明显低于对照组,(162.20±96.33)小时vs (235.00±107.90)小时(P＜0.05).治疗后APACHEⅡ评分的改善明显优于对照组,(8.40±2.17)分vs (11.10±2.42)分(P＜0.05).结论 Ala-Gln治疗可显著提高ALI患者血清Gln、HSP70水平、缩短机械通气时间,改善APACHEⅡ评分,提示Ala-Gln对ALI患者具有保护作用,其机制可能与提高患者体内Gln、HSP70水平有关.%Objective To investigate the protection effect and mechanism of alanyl-glutamine( Ala-Gin) during acute lung injury(ALI). Methods 110 patients with ALI were randomly divided into two groups: control group( n = 50) and Ala-Gin group(n =60), Ala-Gin group received intravenous infusion Ala-Gin in addition to conventional treatment for 7 days,and control group only received conventional treatment, the levels of glutamine(Gln) , heat shock 70 kDa protein( HSP-70) in serums of ALI patients and score of APACHE Ⅱ pre- and post-treatment were compared respectively,and the duration of mechnical ventilation between the two groups was also compared. Results The post-treatment levels of Gin and HSP-70 of Ala-Gin group were statistically higher than pre-treatment levels in the same group and post-treatment levels of control group( P <0. 01) ,Gln of Ala-Gin group: (386. 15 + 68. 60) μg/L vs (304. 72± 73.70) μg/L( P<0. 01);HSP70 of Ala-Gin group: (1. 99 + 0. 66) μg/L vs (1.34±0. 68) μg/L( P <0. 01). Gin of two groups in post-treatment: (303. 74±78. 08) fig/L vs (386. 15±68. 60) μg/L( P <0. 01) ;HSP70 of two groups in post-treatment: (1. 99 + 0. 66) μg/L vs (1. 35±0. 48) μg/L( P <0. 01). Gin concentration ratio of pre-and post treatment was positively correlated with HSP70 concentration ratio of pre-and post treatment ( r =0. 809, P <0. 01) ; There was no significant difference between the pre-and post-treatment levels of Gin and HSP-70 of control group,and there was no significant correlation between Gin concentration ratio and HSP-70 concentration ratio of pre-and post treatment of control group. The duration of mechnical ventilation and the score of APACHE II of two groups had significant differences, (162. 20 + 96. 33) hours vs (235. 00+107. 90) hours( P <0. 05) ; (8. 40 + 2. 17) scores vs (11.10 + 2.42) scores( P <0. 05). Conclusion Ala-Gin treatment can significantly improve Gin, HSP70 levels in patients' serums, shorten duration of mechanical ventilation,improve APACHE TJ score,suggesting that Ala-Gin has a protective effect in patients with ALI,and the mechanism may be related to improve Gin,HSP-70 levels in patients.