Glutamine-enriched enteral nutrition increases HLA-DR expression on monocytes of trauma patients
Glutamine-enriched enteral nutrition increases HLA-DR expression on monocytes of trauma patients
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DOI：
10.1093/jn/132.9.2580
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发表时间：
2002-09-01
影响因子：
4.2
通讯作者：
Van Leeuwen, PAM
中科院分区：
文献类型：
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作者：
Boelens, PG;Houdijk, APJ;Van Leeuwen, PAM
本研究旨在探讨富含谷氨酰胺（Gln）的肠内营养（EN）对多发伤患者单核细胞人类白细胞抗原（HLA）-DR和Fc γ R1/CD 64表达及血浆谷氨酰胺浓度的影响。单核细胞上的HLA-DR表达在将外源抗原呈递给免疫系统中是至关重要的，并且在创伤患者中严重降低。体外单核细胞HLA-DR和Fc γ R1/CD 64表达依赖于谷氨酰胺的可用性。为研究谷氨酰胺肠内营养对CD 14（+）单核细胞HLA-DR和Fc γ R1/CD 64表达的影响，采用随机、双盲、对照试验，对55例多发伤患者进行研究。创伤患者接受富含谷氨酰胺的EN（谷氨酰胺组，n = 28）或等热量、等氮对照EN（对照组，n = 27），并与一组年龄匹配的健康志愿者（健康志愿者，n = 53）进行比较。分别于伤后第1、5、9、14天，用流式细胞仪检测CD 14（+）单核细胞HLA-DR和Fc γ R1/CD 64的表达。使用HPLC测量血浆谷氨酰胺水平。与健康志愿者相比，两个创伤患者组的血浆谷氨酰胺均较低，并且从第3天到第5天;谷氨酰胺组的谷氨酰胺高于对照组。在第1天，HLA-DR表达在两个创伤患者组比健康志愿者低得多。谷氨酰胺组HLA-DR表达在第5、9、14天均高于对照组。创伤患者单核细胞上Fc γ R1/CD 64的表达与健康志愿者的表达没有差异。这项研究表明，谷氨酰胺强化的肠内营养与创伤患者CD 14（+）单核细胞上HLA-DR的高表达有关。在接受两种肠内饮食的患者之间以及创伤患者和健康志愿者之间，检测到单核细胞Fc γ R1/CD 64表达没有差异。HLA-DR表达增加可能改善细胞免疫功能，并可能参与谷氨酰胺对创伤患者感染发生的有益作用。
aim of this study was to investigate the effect of glutamine-(Gln)-enriched enteral nutrition (EN) on human leukocyte antigen (HLA)-DR and FcgammaR1/CD64 expression on monocytes and plasma glutamine concentrations in multi-trauma patients. HLA-DR expression on monocytes is crucial in the presentation of foreign antigen to the immune system and is severely reduced in trauma patients. In vitro monocyte HLA-DR and FcgammaR1/CD64 expression is dependent on glutamine availability. To study the effect of glutamine supplemented enteral nutrition on HLA-DR and FcgammaR1/CD64 expression on CD14(+) monocytes, 55 multi-trauma patients were studied in a randomized, double-blinded, controlled trial. Trauma patients received either a Gln-enriched EN (glutamine group, n = 28) or an isocaloric, isonitrogenous control EN (control group, n = 27) and were compared with a group of age-matched healthy volunteers (healthy volunteers, n = 53). On d 1, 5, 9 and 14 after trauma, expressions of HLA-DR and FcgammaR1/CD64 were determined on CD14(+) monocytes using FACS analysis. Plasma glutamine levels were measured using HPLC. Plasma glutamine was lower in both trauma patient groups compared with healthy volunteers and from d 3 to d 5; glutamine was higher in the glutamine group than in the control group. On d 1, HLA-DR expression was much lower in both trauma patient groups than in healthy volunteers. HLA-DR expression was greater on d 5, 9 and 14 in the glutamine group than in the control group. FcgammaR1/CD64 expression on monocytes of trauma patients was not different than the expression of healthy volunteers. This study showed that glutamine-enriched enteral nutrition was associated with a higher HLA-DR expression on CD14(+) monocytes of trauma patients. No difference in monocyte FcgammaR1/CD64 expression was detected between patients that received the two enteral diets and between trauma patients and the healthy volunteers. Increased HLA-DR expression may improve cellular immune function and may be involved in the beneficial effect of glutamine on the occurrence of infections in trauma patients.