谷氨酰胺强化鼻空肠管营养对老年重症颅脑损伤患者肠黏膜屏障及免疫功能的影响
Effects of nasojejunal nutrition enhanced by glutamine on intestinal mucosal barrier and immune function of old patients with severe traumatic brain injury

目的 探讨谷氨酰胺（Gln）强化的鼻空肠管营养对老年重症颅脑损伤患者肠黏膜屏障及免疫功能的影响。 方法 将67例老年重症颅脑损伤患者随机分成2组：对照组34例，采用常规鼻空肠管营养；观察组33例，添加含有Gln的鼻空肠管营养。分别采集2组患者在鼻空肠管营养前、营养第1周末及第2周末的晨起静脉血，检测其血白蛋白（ALB）、前白蛋白（PA）、血红蛋白（Hb）、二胺氧化酶（DAO），以及免疫球蛋白IgG、IgM、IgA和T淋巴细胞水平亚群（CD4+/CD8+）水平，同时观察2组患者并发症发生情况。 结果 经鼻空肠管营养支持后，2组患者的营养状况均得以明显改善（P<0.05），且第2周末观察组患者的ALB、PA指标改善显著于对照组（P<0.05）；Gln强化营养的观察组DAO水平显著低于对照组（P<0.05），免疫球蛋白IgG、IgM、IgA和CD4+/CD8+等免疫指标也优于对照组（P<0.05），但2组患者相关并发症差异无统计学意义（P>0.05）。 结论 Gln强化的鼻空肠管营养有助于改善老年重症颅脑损伤患者的肠黏膜屏障和增强免疫功能，提高患者营养支持的疗效。
： Objective To investigate the effects of nasojejunal nutrition enhanced by glutamine (Gln) on intestinal mucosal barrier and immune function of old patients with severe traumatic brain injury. Methods A total of 67 old patients with severe traumatic brain injury were randomly divided into 2 groups, i.e. the control group (n=34) that adopted the conventional nasojejunal nutrition and the observation group (n=33) that adopted nasojejunal nutrition with Gln. Venous blood samples of two groups before and one and two weeks after administrating nasojejunal nutrition were collected. Blood albumin (ALB), prealbumin (PA), hemoglobin (Hb), serum diamine oxidase (DAO), immunoglobulin (IgG, IgM, IgA), and T lymphocyte subgroup level (CD4+/CD8+) were detected and complications of two groups were observed. Results Nutritional status of two groups was significantly improved after administrating nasojejunal nutrition (P<0.05) and the levels of ALB and PA of the observation group two weeks after administrating nasojejunal nutrition were significantly higher than those of the control group (P<0.05). The level of DAO of the observation group was significantly lower than that of the control group (P<0.05) and levels of immunoglobulin (IgG, IgM, IgA) and T lymphocyte subgroup (CD4+/CD8+) were better than the control group (P<0.05). But the difference of complications between two groups was not statistically significant (P>0.05). Conclusion Nasojejunal nutrition enhanced by Gln is helpful for improving the intestinal mucosal barrier and immune function of old patients with severe traumatic brain injury and increasing the therapeutic effect of nutritional support