谷氨酰胺强化胃肠外营养对胃肠道恶性肿瘤老年患者术后营养及免疫功能的影响  

Effect of glutamine enriched total parenteral nutrition on nutritional status and immune function in elderly patients after gastrointestinal surgery

作　　者：沈浩[1,2] 龚敏[1,2] 唐伟勇[1,2] 

机构地区：[1]上海市静安区中心医院 [2]复旦大学附属华山医院静安分院普外科,上海200040

出　　处：《世界临床药物》2014年第9期542-546,共5页World Clinical Drug

基　　金：上海市静安区卫生系统"十;百;千"人才建设工程(项目编号:200706B020)

摘　　要：目的观察谷氨酰胺胃肠外营养（Gln-TPN）对胃肠道恶性肿瘤老年患者术后营养及免疫功能的影响。方法选择2009-2013年入住本院的胃肠道恶性肿瘤老年患者40例,随机分成两组,即谷氨酰胺强化的胃肠外营养组（Gln-TPN组）和标准胃肠外营养组（S-TPN组）,每组20例。所有患者均于术后第2 d至第6~8 d,接受5~7 d的全胃肠外营养支持治疗。Gln-TPN组患者在S-TPN组的基础上加入谷氨酰胺（一日0.3~0.6 g/kg）。术前及术后第7 d测患者白蛋白、谷丙转氨酶（ALT）;自然杀伤细胞（NK细胞）、CD3＋、CD4＋、CD8＋细胞水平,CD4＋/CD8＋比值;IgG、IgM水平;并观察患者胃肠道功能恢复情况。结果与S-TPN组相比,Gln-TPN组患者术后第7 d血清白蛋白水平、NK细胞、CD3＋、CD4＋、CD8＋细胞百分比,CD4＋/CD8＋比值;免疫球蛋白IgG、IgM水平均增高,且组间差异具有统计学意义（P〈0.05）。S-TPN组术后免疫功能低于术前水平,而Gln-TPN组却超过了术前水平,组间差异具有统计学意义（P〈0.05）。术后Gln-TPN组胃肠功能的恢复时间也显著少于S-TPN组（P〈0.05）。结论 Gln-TPN可改善胃肠道肿瘤老年患者术后的营养状况,提高机体免疫功能,减轻术后应激反应,有助于患者康复。Objective To observe the effect of glutamine enriched total parenteral nutrition （Gln-TPN）on nutrition and immune function in elderly patients after gastrointestinal surgery. Methods Forty patients suffered gastrointestinal cancer were randomly divided into two groups： S-TPN group （isocaloric and isonitrogenous TPN, n：20）and Gln- TPN group（glutamine enriched TPN, n=20）. The Gln-TPN group was given L-alanyl-L-glutamine, 0.3-0.6 g/（kg.d）. Immunological markers （NK cells, CD3＋, CD4＋, CD8＋ cell percentage, CD4＋/CD8＋, IgG, IgM） and hepatic function markers （ALT） were monitored by the time of preoperative and 7th days after surgery. The postoperative recovery procedural was carefully recorded. Results The levels of albumin and immunological markers （NK cells, CD3＋, CD4＋, CD8＋ cell percentage, CD4＋/CD8＋; immunoglobulin IgG, IgM） of Gln-TPN group were significantly greater than those in the S-TPN group in 7th days after surgery （P〈 0.05）. Immune function of S-TPN group before surgery was lower than that after surgery, and Immune function of Gln-TPN group before surgery was greater than that after surgery （P〈0.05）. Gastrointestinal function recovery time of Gln-TPN group was less than that in S-TPN group （P〈0.05）. Conclusion Gln-TPN can improve the nutritional status of patients more quickly, enhance immune function ease the postoperative stress reaction, and promote rehabilitation.

关 键 词：谷氨酰胺 胃肠道肿瘤 胃肠外营养 免疫 外科手术 老年患者 

分 类 号：R977[医药卫生—药品] R459.5[医药卫生—药学]