较低剂量谷氨酰胺双肽对食管癌患者血浆前白蛋白、细胞免疫及结局的影响  

Effect of Glutamine Dipeptides on Plasma Pre-albumin Level, Immune Function, and Clinical Outcome in Postoperative Patients with Esophageal Carcinoma

作　　者：王振捷[1] 于洪泉[1] 王秀荣[1] 马浩[1] 刘洪生[1] 孙文彦[1] 蒋朱明[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院外科,北京100730

出　　处：《中国临床营养杂志》2005年第6期344-347,共4页Chinese Journal of Clinical Nutrition

基　　金：卫生部临床重点项目(2001-01-03);华瑞2002年奖学金资助

摘　　要：目的观察谷氨酰胺对食管癌患者术后机体蛋白代谢、细胞免疫以及结局的影响。方法将36例行食管癌根治术的患者随机分为研究组和对照组,分别给予等氮等热量营养支持7天,研究组静脉提供N2-L丙氨酰-L 谷氨酰胺双肽1．6 ml／(kg．d),观察治疗前后患者血浆白蛋白、前白蛋白,以及淋巴细胞和亚群包括CD3+、CD4+、 CD8+的变化情况。比较两组围手术期感染相关并发症、住院时间及费用。结果 (1)术前两组的血浆前白蛋白水平低于正常,研究组术后第7天前白蛋白水平恢复正常,且与对照组相比差异有显著性(P=0．042)。 (2)所有患者术前淋巴细胞计数均已下降,以CD4+下降最显著;手术应激造成外周血淋巴细胞及亚型计数进一步下降,以NK 细胞和CD8+下降最显著;研究组术后第7天淋巴细胞计数的增加明显高于对照组(P=0．048),但仍未达到正常。 (3)两组均未发生感染相关并发症,两组住院时间(P=0．785)及费用(P=0．410)差异均无显著性。结论谷氨酰胺双肽能改善食管癌患者术后血前蛋白水平及细胞免疫。Objective To evaluate the effect of intravenously infused alanyl-glutamine on the protein synthesis and lymphocyte count in patients with esophageal carcinoma. Methods Totally 36 patients after esophagogastrostomy were randomized into study group [intravenously supplemented with alanyl-glutamine 1.6 ml/（kg.d）] and control group （receiving standard nutrition）. All patients were treated for 7 days. The levels of plasma protein, albumin, and pre-albumin were measured and the count of lymphocyte and its subgroups were calculated. The clinical outcomes including the complications, hospital stay, and total charge were compared between two groups. Results The pre-albumin levels in both groups were lower than normal before operation. On the 7^th post-operative day （POD）, the pre-albumin level in the study group returned to normal, which was significantly different from the control group （P = 0.042）. Lymphocyte count was lower than normal in all patients before operation, especially for CD4＋; the operation stress further decreased the count of lymphocytes, especially for NK cell and CD8＋. On the 7^th POD, the increase of the count of lymphocytes was significantly larger in the study group than in control group （P = 0.048）; however, the count of lymphocytes did not return to normal level in either group. （3） No infection-related complication was found in both two groups. The differences of hospital stay and total charge were not significant （P = 0.785, P = 0.410, respectively）. Conclusion Glutamine can improve the pre-albumin level and immune function in postoperative patients with esophageal carcinoma.

关 键 词：谷氨酰胺 前白蛋白 淋巴细胞计数 结局 

分 类 号：R735.1[医药卫生—肿瘤]