谷氨酰胺和生长激素对门静脉高压症术后营养状态和肠黏膜屏障的影响  

Effects of glutamine and growth hormone on nutritional status and intestinal mucosal barrier in patients with portal hypertension after surgical operation

作　　者：方和平[1] 邓美海[1] 汤照峰[1] 林楠[1] 许瑞云[1] 

机构地区：[1]中山大学附属第三医院肝胆外科,广州510630

出　　处：《中华实验外科杂志》2008年第6期792-794,共3页Chinese Journal of Experimental Surgery

基　　金：广东省科技计划资助项目（20078031511007）;广东省医学科学基金资助项目（A2007196）

摘　　要：目的观察谷氨酰胺和生长激素联合肠外营养对肝硬化门静脉高压症手术患者术后营养状态和肠黏膜屏障的影响。方法选择58例接受门静脉高压症手术的肝硬化患者，随机分为两组：实验组（添加谷氨酰胺和重组人生长激素，n=30）和标准营养组（对照组，n=28），两组术后第3天开始进行等氮等热量（每天125kJ／kg体重）营养支持，持续7d。术前、术后第3和第10天清晨分别抽取静脉血检测血清前白蛋白、转铁蛋白，并对手术前、后的尿乳果糖／甘露醇排泄率比值（IMM）、十二指肠黏膜绒毛高度、陷窝深度及肠黏膜增殖细胞核抗原（PCNA）指数进行对比。结果实验组在术后第10天血清前白蛋白：（199．81±8．77）mg／L、转铁蛋白：（2．28±0．19）mg／L均显著高于对照组（P〈0．05），L/M值升高小于对照组（P〈0.05），肠黏膜绒毛高度（375.15±23．64）μm和陷窝深度（128．53±16．42）μm均大于对照组（P〈0.05）及术前（P〈0.05），肠黏膜上皮PCNA指数（24．27±4．25）大于对照组（P〈0．05）。结论谷氨酰胺和生长激素联合肠外营养能够改善门静脉高压症手术后营养状态，降低小肠黏膜通透性，并维护肠黏膜形态学完整性，作用优于标准胃肠外营养。Objective To evaluate the effects of postoperative glutamine and growth hormone enhancing parenteral nutrition on the nutritional status and intestinal mucosal barrier in patients undergoing portal hypertension surgery. Methods This study was designed as a prospective, randomized and controlled clinical trial. Fifty-eight patients undergoing portal hypertension surgery were randomly divided into 2 groups ： experimental group （ receiving an enhancing parenteral nutrition by adding glutamlne and recom- binant human growth horlnone, n = 30 ） and control group （ receiving an isocaloric and isonitrogenous standard parenteral nutrition,n = 28）. Parenteral nutrition providing 125 kJ · kg^-1 · d^-1 was initiated 3 days after surgery in both groups and lasted for 7 days： Blood samples were obtained before and 3 and 10 days after operation. Host nutritional status was evaluated by measuring levels of prealbumin and transferrin. The concentration ratio of urinary lactulose to mannkol （L/M） , the villus height and crypt depth and PCNA index of small intestinal mucosa were compared, respectively. Results Ten days after operation, among patients receiving an enhancing parenteral nutrition, the serum prealbumin was （ 199.81 ± 8.77 ） mg/L and transferrin was （2.28 ± 0.19） mg/L,which were significantly higher than those in the control group （ P 〈 0.05 ）. The villi height and crypt depth were increased in experimental group as compared with those before operation or control group （ P 〈 0.05 ）. PCNA index in experimental group was 24.27 ± 4.25, which was higher than in control group （ P 〈 0.05 ）. Conclusion Postoperative administration of glutamine and growth hormone enhancing parenteral nutrition in patients undergoing portal hypertension surgery can improve nutritional status ,reduce the intestinal permeability and protect the mucosal integrality.

关 键 词：肝硬化 门静脉高压症 胃肠外营养 肠黏膜屏障 

分 类 号：R657.34[医药卫生—外科学] R644[医药卫生—临床医学]