肠外与肠内营养谷胱甘肽课件.ppt

The Role of Glutathione in Cell Defense, with References to Clinical Deficiencies and Treatment Thomas A. Kwyer, M.D. Glutathione Precursors: Amino Acids L-Glutamate L-Cysteine the rate-limiting substrate cystine (cysteine=cysteine) is an ideal form of cysteine for glutathione synthesis Glycine Glutathione: L-glutamylcysteinylglycine DNA synthesis and repair Protein synthesis Prostaglandin synthesis Amino acid transport Metabolism of toxins and carcinogens Immune system enhancement Prevention of oxidative cell damage Enzyme activation Lomaestro, B. Ann Pharmacother, 1995 Dec;(12):1263 -73. Immunonutrition in the Critically Ill: a Systematic Review of Clinical Outcomes (12 studies with 1,557 subjects, 1,482 of whom were analyzed) “Objective: To perform a meta-analysis addressing whether enteral nutrition with immune-enhancing feeds benefit critically ill patients after trauma, sepsis, or major surgery.” “Main outcome measures were mortality, infection,ventilator days, intensive care unit stay, hospital stay, diarrhea days, calorie intake and nitrogen intake.” Beale, R., Crit. Care Med. 1999, Dec.;27(12):2799-805. Immunonutrition in the Critically Ill: a Systematic Review of Clinical Outcomes (Summary) BENEFITS: Infection: a significant reduction in the relative risk of acquiring infection. Ventilator Days: a significant reduction overall. Hospital Length of Stay: the reduction in hospital LOS was significant. SAFETY: No increase in side effects of feeding was reported in patients receiving immunonutrition. Effect of Immune Enhancement on Length of Therapeutic Intervention in Severe Abdominal Trauma Effect of Immune Enhancement on Total Hospitalization Cost in Severe Abdominal Trauma Effect of Immune Enhancement on Total Hospital Days in Severe Abdominal Trauma Pathogenesis of Glutathione Deficiency: Cytokine Selection (Slide 1) “Glutathione Levels in Antigen-presenting Cells Modulate Th1 Versus Th2 Response Patt