丙氨酰-谷氨酰胺强化肠外营养对结肠癌合并肠梗阻患者炎症反应及免疫功能的调节作用

Effect of alanyl-glutamine parenteral nutrition on inflammatory response and immunological function in patients with colon cancer and intestinal obstruction

摘要:

目的  探讨丙氨酰-谷氨酰胺强化肠外营养对结肠癌合并肠梗阻患者炎症反应及免疫功能的影响。方法  选取100例结肠癌合并肠梗阻患者，分为观察组和对照组，每组50例。对照组仅给予标准肠外营养，观察组加用丙氨酰-谷氨酰胺100ml/d。比较两组手术前后血清前白蛋白、白蛋白、免疫球蛋白A（IgA）、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）水平。统计患者住院期间并发症发生率。结果  术前及术后3 d，两组患者血清前白蛋白、白蛋白、IgA、IgG、IgM、TNF-α、IL-6水平比较，差异无统计学意义（P >0.05）；术后7 d，与对照组比较，观察组患者血清前白蛋白、白蛋白、IgA、IgG、IgM水平增高（P <0.05），TNF-α、IL-6水平降低（P <0.05）。观察组并发症发生率低于对照组（4.0% vs 16.0%）（P <
0.05）。结论  结肠癌合并肠梗阻围手术期采用丙氨酰-谷氨酰胺强化肠外营养，可显著增强营养，提高机体免疫力，抑制炎症反应，降低感染率，其效果优于标准肠外营养。

Abstract:

Objective To evaluate the effect of alanyl-glutamine parenteral nutrition on inflammatory response and immunological function in patients with colon cancer and intestinal obstruction. Methods One hundred patients with colon cancer and intestinal obstruction were divided into observation group and control group with 50 in each group. The control group was given norm parenteral nutrition, and the observation group was given additional alanyl-glutamine (100 ml/d). The serum levels of prealbumin, albumin, IgA, IgG, IgM, tumor necrosis factor-α (TNF-α) and interleukin 6 (IL-6) were compared between the two groups. The complication rate of the patients during hospitalization was calculated. Results The serum levels of prealbumin, albumin, IgA, IgG, IgM, TNF-α and IL-6 of the two groups were not statistically different before operation and 3 d after operation (P > 0.05). Compared with the control group, the serum levels of prealbumin, albumin, IgA, IgG and IgM of the observation group significantly increased (P < 0.05), and the TNF-α and IL-6 levels of the observation group significantly decreased (P < 0.05) on the 7th d after operation. The complication rate of the observation group was significantly lower than that of the control group (4.0% vs 16.0%, P < 0.05). Conclusions Alanyl-glutamine parenteral nutrition used during the perioperative period in patients with colon cancer and intestinal obstruction can significantly enhance nutrition, improve body immunity, restrain inflammation and reduce infection rate. Its effect is better than that of the standard parenteral nutrition.