丙氨酰谷氨酰胺双肽肠外营养在胃肠道肿瘤化疗中应用的前瞻性研究  

Application of parenteral nutrition with alanyl-glutamine dipeptide in chemotherapy of gastrointestinal neoplasms:a prospective study

作　　者：彭亦良[1] 龚茜芬[1] 王自强[1] 

机构地区：[1]第三军医大学西南医院肿瘤科,重庆400038

出　　处：《肿瘤》2006年第7期682-684,共3页Tumor

摘　　要：目的:评价丙氨酰谷氨酰胺(AlaGln)双肽肠外营养(parenteralnutrition,PN)在胃肠道肿瘤患者化疗中的应用价值。方法:采取双盲、随机试验,48例胃肠道肿瘤患者随机分为常规PN组(对照组)24例和PN+AlaGln组(试验组)24例,所有患者在化疗期间给予等热量[92.0kJ/(kg·d)]、等氮[0.2g/(kg·d)]的肠外营养治疗,试验组另外添加[0.5g/(kg·d)]的AlaGln双肽。观察化疗前后血清白蛋白、血清前蛋白、氮平衡变化,并检测化疗前后外周血lgG、lgM、lgA、C3、C4的变化。结果:化疗期间试验组患者胃肠道反应低于对照组(P<0.05);2组患者血清白蛋白、前白蛋白在化疗后第4天均明显下降,化疗后第8天时继续下降,但对照组下降更快,2组比较有显著性差异(P<0.05);2组患者化疗后第4天IgG、IgA、IgM值均低于化疗前,化疗后第8天IgG、IgA、IgM进一步降低,但试验组下降较慢,与对照组比较有显著性差异(P<0.05)。试验组化疗后第8天C3、C4值也高于对照组(P<0.05);试验组化疗后第8天氮平衡明显优于对照组(P<0.01)。结论:在胃肠道肿瘤患者化疗中应用AlaGln双肽肠外营养可明显减轻化疗的毒副作用,有助于改善患者化疗期间的营养状况、体重、蛋白质、相关免疫学及氮平衡等指标。Objective： To evaluate the benefits of parenteral nutrition （PN） with alanyl-glutamine dipeptide（Ala-Gln） in the chemotherapy of gastrointestinal neoplasms. Methods.. Prospective, double-blind, controlled, randomized trial was performed. Forty eight patients with gastrointestinal neoplasms were randomly divided into PN group（control group,n=24） and PN plus Ala-Gln group （n = 24）. Patients were randomized to receive isocaloric [92.0 kJ/（kg · d） ] and isonitrogenous [0.2 g/（kg · d） ] PN supplemented with or without Ala-Gln [0.5 g/（kg · d）] during chemotherapy. The serum albumin and pre-albumin levels and peripheral blood IgG,IgM, IgA,C3 ,and C4 levels were measured before and after chemotherapy （day 1 and day 8）. Nitrogen balance was calculated at the same time. Results： The gastrointestinal reaction was lower in PN plus Ala-Gln group than that in control group（P〈0.05）. Serum albumin and pre-albumin levels were both decreased in two groups on day 4 after chemotherapy and was continuously decreased on day 8. The decreasing speed was more rapid in control group than PN plus Ala-Gln group （P 〈0.05）. The IgG,IgA,and IgM levels of the two groups were decreased after chemotherapy and were further decreased on day 8. The levels of IgG, IgA, and IgM decreased more slowly in PN plus Ala-Gln group compared with control group （P〈0.05）. C3 and C4 levels were higher in PN plus Ala-Gln group than that in control group on day 8 after chemotherapy （P〈0.05）. Nitrogen balance in PN plus Ala-Gln group was better than that in control group on day 8 after chemotherapy （P〈0. 05）. Conclusion：Application of PN supplemented with Ala-Gln in patients with gastrointestinal neoplasms could reduce the side effects of chemotherapy. It helps to improve the nutritional status, weight, serum protein, related immune index as well as the nitrogen balance of patients.

关 键 词：胃肠道肿瘤 肠外营养 丙氨酰谷氨酰胺双肽 化学疗法 

分 类 号：R735.2[医药卫生—肿瘤] R735.3[医药卫生—临床医学]