不同剂量L-精氨酸对严重烧伤患者辅助性T淋巴细胞型细胞因子的影响

目的 了解不同剂量L-精氨酸对严重烧伤患者血清辅助性T淋巴细胞1(Th1)/Th2型细胞因子水平的影响.方法 选择笔者单位收治的伤后20 h内入院、烧伤总面积为50%～80%TBSA的患者29例,按随机数字表法分为对照组10例,经鼻肠管给予葡萄糖盐水500 mL(含50 g/L葡萄糖及9 g/L氯化钠,下同)]、L-精氨酸200 mg组(10例,经鼻肠管给予L-精氨酸200 mg/kg+葡萄糖盐水500 mL)、L-精氨酸400 mg组(9例,经鼻肠管给予L-精氨酸400 mg/kg+葡萄糖盐水500mL).于伤后1 d(行肠内营养前)及3、5、7 d,取各组患者空腹静脉血,用放射免疫法及酶联免疫吸附测定法检测血清Th1型细胞因子TNF-α、IL-1β和Th2型细胞因子TGF-β_1、IL-4含量.结果 各组患者血清TNF-α及IL-1β含量伤后均呈快速上升趋势,L-精氨酸200 mg组血清TNF-α及IL-1β含量伤后5 d达高峰(318±57)ng/mL、(218±47)pg/mL],但仍显著低于同时相点对照组(389±34)ng/mL、(272±40)pg/mL,P<0.05],伤后7 d此2种细胞因子含量下降;L-精氨酸400 mg组各时相点血清TNF-α及IL-1β含量与对照组相近(P>0.05).各组患者血清TGF-β_1及IL-4含量伤后呈较缓慢上升趋势;伤后5 d,L-精氨酸200 mg组血清TGF-β_1含量为(110±16)pg/mL,显著高于对照组(83±20)pg/mL,P<0.05],L-精氨酸400mg组各时相点血清TGF-β_1含量与对照组相近(P>0.05).结论 在严重烧伤患者感染期,相对于400 mg/kg的用量,200 mg/kg的L-精氨酸通过调节血清Th1/Th2型细胞因子释放,能更有效地保持两者之间的比例,从而产生更好的免疫调理作用.

Effects of different doses of L-arginine on the serum levels of helper T lymphocytel (Th1)/Th2 cytokines in severely burned patients

Objective To investigate the effects of L-arginine in different doses on the serum levels of helper T lymphocytel (Th1)/Th2 cytokines in severely burned patients. Methods Twenty-nine se-verely burned patients, with total burn surface area from 50% to 80% TBSA, hospitalized within 20 hours af-ter burn, were randomly divided into control group (10 cases, fed with 5% glucose saline 500 mL), L-argi-nine 200 mg group (10 cases, fed with 5% glucose saline 500 mL + 200 mg/kg L-arginine) , L-arginine 400 mg group (9 cases, fed with 5% glucose saline 500 mL + 400 mg/kg L-arginine). All patients received en-teral feeding through nasointestinal tube, started within 22 hours after burn. Fasting venous blood of all pa-tients was harvested on post burn day (PBD) 1 (before enteral feeding), 3, 5, and 7 to determine serum contents of TNF-α, IL-1β, TGF-β_1 and IL-4 by radio-immunity method and enzyme-linked immunosorbent assay. Results Serum contents of TNF-α and IL-1β of patients in all groups increased rapidly after burn, and although contents of TNF-α (318±57) ng/mL and IL-1β (218 ±47) pg/mL of patients in L-arginine 200 mg group peaked on PBD 5, they were still significantly lower than those of patients in control group (389±34) ng/mL, (272±40) pg/mL, P <0.05], but they decreased on PBD7. Serum contents of TNF-α and IL-1β in L-arginine 400 mg group were close to those of control group (P > 0.05). Serum con-tents of TGF-β_1 and IL-4 of patients in each group increased slowly after burn, and content of TGF-β_1 (110± 16) pg/mL of patients in L-arginine 200 mg group was significantly higher than that of patients in control group (83 ± 20) pg/mL, P <0.05] on PBD 5. There was no statistical significant difference between L-arginine 400 mg group and control group in respect of serum content of TGF-β_1(P> 0.05). Conclu-sions Compared with the dosage of 400 mg/kg L-arginine, the 200 mg/kg dose is more effective in reduc-ing the release of Thi cytokines and increasing Th2 eytokines production, hence maintaining Th1/Th2 cyto-kine ratio to produce better immune opsonization during the infection phase of severe burn.