Role of glutamine administration on T-cell derived inflammatory response after cardiopulmonary bypass
Role of glutamine administration on T-cell derived inflammatory response after cardiopulmonary bypass
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DOI：
10.1016/j.clnu.2008.08.007
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发表时间：
2009-02-01
影响因子：
6.3
通讯作者：
Hempelmann, G.
中科院分区：
文献类型：
--
作者：
Engel, J. M.;Pitz, S.;Hempelmann, G.
背景和目标：心脏手术引起炎症反应，内皮、心肌和单核细胞/巨噬细胞是主要原因。T细胞以不同的方式改变，从而抑制促炎途径。从实验研究的结果可以得出结论，谷氨酰胺（Gin）增强生产的条件下，Gin剥夺T细胞的细胞因子。本临床研究的目的是评估围手术期输注Gin对择期心脏手术患者细胞内炎性T细胞因子表达的作用，并评估对全身炎症、器官功能障碍和ICU住院时间的影响。方法：在这项前瞻性、随机、双盲研究中，我们纳入了78名患者，（年龄水平大于70岁，射血分数小于40%，或二尖瓣置换术）接受择期心脏手术和心肺转流术。我们随机分配每个受试者接受输注Gin（0.5 g/kg/天，A组）或等氮、等热量、等容量营养液（B组）或生理NaCl 0.9%（C组，以消除所有非特异性营养效应）。我们在麻醉诱导后开始以1000 ml/24 h输注，并维持该状态3 d。A组术后第1天血浆Gln水平明显升高（958 +/- 331 μ M），与组B（527 +/- 105 μ M）和组C（489 +/- 104 μ M）相比，并保持较高，直到术后第三天。在手术开始时和手术后，T细胞中的细胞内白细胞介素（IL）-1，IL-6，IL-8和肿瘤坏死因子-α水平在两组之间没有差异。此外，没有差异，可以观察到C-反应蛋白，SOFA评分，心脏和循环支持，术后通气时间，ICU住院时间longthofstay.Conclusions：由于0.5 g/kg/天围手术期Gin输注的Gin血浆水平的升高对T细胞衍生的炎症反应没有影响，表明足够的Gin供应。在没有明显的Gin缺乏的心脏手术患者中补充Gin似乎不影响细胞内炎性T细胞细胞因子的表达。(c)2008年爱思唯尔有限公司和欧洲临床营养与代谢学会。All rights reserved.
Background & aims: Cardiac surgery provokes an inflammatory response for which the endothelium, the myocardium, and monocytes/macrophages are primarily responsible. T cells are altered in a different way whereby the pro-inflammatory pathway is suppressed. From the results of experimental studies it was Concluded that glutamine (Gin) enhances the production of T-cell cytokines in conditions of Gin deprivation. The aim of this clinical Study was to evaluate the role of a perioperative Gin infusion on intracellular inflammatory T-cell cytokine expression in patients undergoing elective cardiac Surgery and to evaluate the effects on systemic inflammation, organ dysfunction and ICU length of stay.Methods: in this prospective, randomized, double-blind Study, we included 78 patients (age level older than 70 years, ejection fraction less than 40%, or mitral valve replacement) undergoing elective cardiosurgery with cardiopulmonary bypass. We randomly assigned each Subject to receive an infusion with either Gin (0.5 g/kg/day, group A) or an isonitrogenous, isocaloric, isovolemic nutritional solution (group B) or physiological NaCl 0.9% (group C, to eliminate all unspecific nutritional effect). We started the infusion after the induction of anesthesia with 1000 ml/24 h and maintained this state for 3 days.Results: On the first postoperative clay plasma GIn levels in group A were significantly increased (958 +/- 331 mu M) compared to group B (527 +/- 105 mu M) and group C (489 +/- 104 mu M), and remained higher until the third postoperative day. At the beginning and after surgery intracellular interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor-a levels in T cells showed no differences between the groups. Also, no differences could be observed with regard to C-reactive protein, SOFA score, heart and circulation support, postoperative ventilation time, and ICU length of stay.Conclusions: The elevation of Gin plasma levels as a result of 0.5 g/kg/day perioperative Gin infusion has no influence on the T-cell derived inflammatory response, indicating a sufficient supply of Gin. A Gin Supplementation in cardiac surgery patients without a clear Gin deficiency seems not to affect the intracellular inflammatory T-cell cytokine expression. (c) 2008 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.