谷氨酰胺对热休克蛋白70和白介素6/10的影响：对比重症儿童补充谷氨酰胺与标准肠外营养的随机试验

Clin Nutr. 2016 Feb;35(1):34-40.

Glutamine effects on heat shock protein 70 and interleukines 6 and 10: Randomized trial of glutamine supplementation versus standard parenteral nutrition in critically ill children.

Jordan I, Balaguer M, Esteban ME, Cambra FJ, Felipe A, Hernández L, Alsina L, Molero M, Villaronga M, Esteban E.

Hospital de Sant Joan de Déu, Barcelona, Spain.

University of Barcelona, Barcelona, Spain.

Hospital Sant Joan de Déu, Barcelona, Spain.

BACKGROUND & AIMS: To determine whether glutamine (Gln) supplementation would have a role modifying both the oxidative stress and the inflammatory response of critically ill children.

METHODS: Prospective, randomized, double-blind, interventional clinical trial. Selection criteria were children requiring parenteral nutrition for at least 5 days diagnosed with severe sepsis or post major surgery. Patients were randomly assigned to standard parenteral nutrition (SPN, 49 subjects) or standard parenteral nutrition with glutamine supplementation (SPN + Gln, 49 subjects).

RESULTS: Glutamine levels failed to show statistical differences between groups. At day 5, patients in the SPN + Gln group had significantly higher levels of HSP-70 (heat shock protein 70) as compared with the SPN group (68.6 vs 5.4, p = 0.014). In both groups, IL-6 (interleukine 6) levels showed a remarkable descent from baseline and day 2 (SPN: 42.24 vs 9.39, p < 0.001; SPN + Gln: 35.20 vs 13.80, p < 0.001) but only the treatment group showed a statistically significant decrease between day 2 and day 5 (13.80 vs 10.55, p = 0.013). Levels of IL-10 (interleukine 10) did not vary among visits except in the SPN between baseline and day 2 (9.55 vs 5.356, p < 0.001). At the end of the study, no significant differences between groups for PICU and hospital stay were observed. No adverse events were detected in any group.

CONCLUSIONS: Glutamine supplementation in critically-ill children contributed to maintain high HSP-70 levels for longer. Glutamine supplementation had no influence on IL-10 and failed to show a significant reduction of IL-6 levels.

KEYWORDS: Glutamine; HSP-70; Inflammatory mediators; Parenteral nutrition; Pediatric intensive care unit

PMID: 25701159

DOI: 10.1016/j.clnu.2015.01.019