Glutamine for immunomodification and metabolic support in patients with chronic obstructive pulmonary disease / 中国组织工程研究

ABSTRACT

BACKGROUND: Nutritional support has become one of the most important therapeutic measures for malnutrition patients with chronic obstructive pulmonary disease (COPD), but some of the patients may fail to respond to nutritional treatment, which might be attributed to excessive inflammatory reaction that increases energy expenditure. Current nutritional support strategies have primarily focused on immunonutrition and metabolic support.OBJECTIVE: To study the effect of glutamine (Gln) on immunomodulation and metabolic support for patients with COPD.DESIGN: Randomized controlled trial.SETTING: Xinhua Hospital Affiliated to Shanghai Second Medical UniversityPARTICIPANTS: Totally 44 male patients with acute episode of COPD aged (75±9) years admitted between February and July 2002 were recruited in this study and randomly divided into treatment group (n=14) and control group (n=18).INTERVENTIONS: Only nutritional support was given in the control group while the treatment group received also glutamine treatment. All the patients received nutritional support with the total calorie intake of 1.5times of resting energy expenditure and dietary counseling for a regular diet (20% protein, 30% fat, and 50% carbohydrate) provided by a nutritionist. In the treatment group, the protein intake was reduced by 30 g and replaced by 30 g of Gln given at 10 g each time for three times a day via oral therapy. The nutritional indices were measured including body mass,body mass index, triceps skinfold thickness (TSF), creatinine-height index (CHI), prealbumin (PAlb), albumin (ALB), transferrin (TRF), fat mass (FM)]and the immune indices examined including immunoglobulin, complements, T cell subsets, interleukin (IL)-2, tumor necrosis factor-α (TNF-α),and C-reactive protein etc with also measurement of resting energy expenditure.MAIN OUTCOME MEASURES: Changes in nutritional and immune indices of patients before and after treatment.RESULTS: Thirty-two patients all entered the result analysis. [1] TSF In the treatment group, TSF increased significantly from (6.3±1.8) mm before treatment to (8.7±1.6) mm after treatment (P ＜ 0.05), which was significantly greater than that in the control group after treatment [(7.3±1.3) mm,P ＜ 0.05]. [2]Palb Palb was significantly increased after treatment in the treatment group from (0.15±0.04) to (0.23±0.05) g/L (P ＜ 0.01), which was significantly higher than that in the control group [(0.22±0.08) g/L, P＜ 0.05)]. [3]T cell subsets in the treatment group, CD3 in creased significantly from 59±10 before treatment to 72±10 after treatment (P ＜ 0.01), a level significantly higher than that in the control group after treatment (62±9, P ＞ 0.01). [4] TNF-αTNF-α in the treatment group before treatment was significantly higher than that after treatment [(72±7) vs (56±5) ng/mL,P ＜ 0.05)], and after treatment TNF-α in the treatment group was significantly lower than that in the control group [(67±11) ng/mL, (P ＜ 0.05)]. [5]Immunoglobin IgG increased slightly after treatment in the treatment group[(12±3) vs (13±3) g/L, P ＜ 0.05)], which was higher than that in the control group [(12±4) g/L], but the difference was not significant (P ＜ 0.05).CONCLUSION: Gln treatment in addition to nutritional support can promote cellular immune function, depress excessive inflammatory reaction and lower energy expenditure in patients with COPD, and such strategy also further enhance the effect of nutritional support.