丙氨酰谷氨酰胺对重型颅脑损伤患者肠黏膜通透性和血浆二胺氧化酶的研究

摘要

目的 探讨丙氨酰谷氨酰胺对重型颅脑损伤患者肠黏膜通透性及血浆二胺氧化酶的影响.方法 选择2014年9月至2016年3月该院重症监护室收治的78例重型颅脑损伤患者,根据患者接诊时间进行编号后将单双号分成2组,均采取综合治疗,39例单号患者为对照组,接受普通营养支持,39例双号患者为观察组,同时给予丙氨酰谷氨酰胺增强营养支持,比较2组患者的治疗效果.结果 治疗后观察组患者营养代谢指标血清清蛋白(ALB)为(37.78 ± 4.20)g/L、转铁蛋白(T RF)为(2.38 ± 0.36)g/L、前清蛋白(PA)为(0.48 ± 0.04)g/L与治疗前比较,差异有统计学意义(t=7.70、7.48、6.80,P<0.05);且与对照组比较,差异有统计学意义(t=7.03、6.87、6.30,P<0.05).治疗后观察组患者免疫球蛋白A(IgA)(2.79 ± 0.36)g/L、免疫球蛋白G(IgG)(13.76 ± 1.64)g/L、免疫球蛋白M(IgM)(2.28 ± 0.42)g/L与治疗前比较,差异有统计学意义(t=7.43、7.30、7.04,P<0.05);且与对照组比较,差异有统计学意义(t=6.60、6.81、6.30,P<0.05).与对照组比较,观察组患者治疗后第3、7天时乳果糖排泄率[(0.25 ± 0.05)%、(0.18 ± 0.06)% ]明显降低(t=6.56、6.81, P<0.05);治疗后第3、7天时血浆二胺氧化酶(DAO)[(2.92 ± 0.25)、(1.57 ± 0.18)U/mL]明显降低(t=7.20、6.92,P<0.05);治疗后第1、3、7天时D-乳酸[(0.19 ± 0.04)、(0.15 ± 0.05)、(0.09 ± 0.06)μg/L]均明显降低(t=7.52、8.02、8.29,P<0.05);治疗后第3、7天时内毒素(L PS)[(0.27 ± 0.06)、(0.16 ± 0.03)U/L]明显降低(t=6.88、7.20,P<0.05).结论 丙氨酰谷氨酰胺用于重症颅脑损伤患者能纠正营养代谢障碍,改善患者营养状况,保护肠道黏膜屏障功能,提高机体免疫力.%Objective To explore the effect of glutamine on intestinal permeability and plasma level of two amine oxidase in patients with severe traumatic brain injury.Methods A total of 78 patients with severe brain injury in our hospital intensive care unit from September 2014 to March 2016 were selected into clinical re-search,they were divided into two groups according to the single number of reception time number,all take comprehensive treatment,39 cases with a single number as the control group,they were given general nutrition support,39 cases of double number as the observation group were given glutamine enhanced,analyze the difference of curative effect.Results The nutritional and metabolic indexes after treatment of the observation group were ALB(37.78 ± 4.20)g/L,TRF(2.38 ± 0.36)g/L,PA(0.48 ± 0.04)g/L and were significantly in-creased(t=7.70,7.48,6.80,P<0.05);there were significant differences compared with the control group(t=7.03,6.87,6.30,P<0.05).After treatment the levels of IgA(2.79 ± 0.36)g/L,IgG(13.76 ± 1.64)g/L,IgM (2.28 ± 0.42)g/L of the observation group significantly increased than those before treatment(t=7.43,7.30, 7.04,P<0.05);And there was significant difference compared with those in the control group(t=6.60,6.81, 6.30,P<0.05).Compared with the control group,the rate of milk fructose excretion 3 d[(0.25 ± 0.05)% ] and 7 d[(0.18 ± 0.06)]% in the observation group significantly reduced(t=6.56,6.81,P<0.05),DAO of 3 d and 7 d[(2.92 ± 0.25),(1.57 ± 0.18)U/mL]significantly reduced(t=7.20,6.92,P<0.05),D-lactic acid at 1,3,7 d were[(0.19 ± 0.04),(0.15 ± 0.05),(0.09 ± 0.06)μg/L],LPS at 3 d[(0.27 ± 0.06)U/mL,7 d(0.16 ± 0.03)U/mL]significantly reduced(t=7.52,8.02,8.29,P<0.05),the above indexes significantly re-duced than those in the control group(t=6.88,7.20,P<0.05).Conclusion Using of glutamine in patients with severe brain injury can correct nutritional and metabolic disorders,improve the nutritional status of pa-tients,protect the intestinal mucosal barrier function,improve the body immunity,can provide the reference for clinical application and use for reference.