The Effects of Parenteral Glutamine Supplementation on Immunological Modulation in Extensive Burn Injury Patients

靜脈給予Glutamine對嚴重燒燙傷病患免疫機能調控之影響

張長正(Chang-Cheng Chang) ； 楊瑞永(Jui-Yung Yang) ； 黃俊源(Jiung-Yuan Huang) ； 馮中和(Chung-Ho Feng) ； 莊秀樹(Shiow-Shuh Chuang)

《中華民國整形外科醫學會雜誌》 18卷1期 (2009/03) Pp. 27-34

https://doi.org/10.7096/JPSA.200903.0027

摘要

背景：
Glutamine是免疫細胞重要的能量來源。許多臨床研究已經支持在嚴重燒燙傷的病人身上給予Glutamine對免疫機能的維持及預後的改善有所助益。
目的及目標：
本研究藉著觀查嚴重傷燙傷病人在施予glutamine治療後T淋巴細胞和B淋巴細胞數目及分類百分比(%)的改變，來推斷Glutamine對其免疫機能所造成的調控及影響。
材料及方法：
從2006年七月到2007年九月，有七位平均燒傷面積達65.57±13.59%，介於50-90%的嚴重燙傷病人選入此一前瞻性研究。每位病人靜脈給予每天20公克共七天的glutamine。在治療首日及第八日分
別偵測T淋巴細胞，B淋巴細胞，以及CD4+細胞的數目(μL^(-1))，還有各淋巴球之分類百分比(%)這些免疫的相關指標並做比較。
結果：
T 淋巴球數目（721±571 及361±124μL^(-1), p=0.149）和B淋巴球數目(311±210 and 190±155μL-1, p=0.267)在施打glutamine後並沒有顯著改變。但T淋巴球的分類百分比卻有統計學上的顯著上升（59.77±16.72%及71.27±10.94%, p=0.009）。上升的幅度在起始有較低的T淋巴球百分比的病人中尤為明顯。然而在B淋巴球的分類百分比比較中卻呈現下降趨勢（29.24±12.96%及19.93±12.08%, p=0.154）。即使CD4+細胞數目上亦無顯著上升，（3.57±2.75及2.52±1.10 10^3/μL, p=0.437），但就CD4+細胞分類百分比而言，同樣是具有統計意義的顯著上升（30.93±7.99%及43.96±3.21%,p=0.01）。
結論：
在嚴重燒燙傷造成的免疫抑制病人靜脈給予glutamine會提升T淋巴球包括CD4+細胞的分布百分比。淋巴球分類比例的改變可以代表Glutamine對細胞免疫影響較體液免疫為多。其可能路徑應該是透過刺激CD4+細胞使免疫機能回復並作調節。

並列摘要

Background:
Glutamine is an important energy source for immune cells. Several clinical trials have supported that glutamine supplementation in severely burned patients can maintain the immunologic function and improve the outcome.
Aim and Objectives:
The aim of this clinical study was to observe the effects of glutamine supplementation on immunologic modulation in extensive burn injury patients from the alternations of T cell and B cell lymphocytes counts and their differentiated ratios.
Materials and methods:
From July 2006 to September 2007, seven patients with extensive burn (total burn surface area 65.57±13.59%, range: 50%-90%) were enrolled in this prospective clinical trial. Patients received parenteral glutamine in doses of 20 g/day for 7 days. Alterations in immunologic function indices including T cell, B cell, CD4+ cell counts (μL^(-1)), differentiated count ratios (%), and the changes of CD4/CD8 ratio were determined on the 1st day and the 8th day from the initiation of glutamine treatment. The pre-treatment data on the 1st day was then compared with the post-treatment data on the 8th day.
Results:
There were no significant changes between the T cell (721±571 and 361±124 μL^(-1), P=0.149) and B cells counts (311±210 and 190±155 μL^(-1), P=0.267) after glutamine therapy. The T cell differentiated count ratio after glutamine supplementation was significantly higher than before treatment (59.77±16.72% and 71.27±10.94%, P=0.009). We especially observed a greater increase in patients with lower initial T cell differentiated count ratio. However, there was a decrease in B cell differentiated count ratios (29.24±12.96% and 19.93±12.08%, P=0.154). Although the CD4+ cell counts did not increase significantly after parenteral glutamine supplementation, (357±275 and 252±110 μL^(-1), P=0.437), we found the CD4+ differentiated count ratio increased significantly after glutamine therapy (30.93±7.99% and 43.96±3.21%, P=0.01).
Conclusion:
Parenteral glutamine supplementation in extensive burn patients increases the Tlymphocyte and CD4+ cell differentiated count ratios, as well as modulate the cellular immunologic function rather than the humoral response. The possible process is first to stimulate the helper T (CD4+) cells, which play the most important role in initiation of immunologic function and regulation.

並列關鍵字

glutamine ； extensive burns ； immunologic modulation