含中低剂量谷氨酰胺全肠外营养对炎症性肠病患者炎症指标改善的影响  

Impact of a low-to-middle dosage of glutamine-supplemented total parenteral nutrition on inflammatory markers in patients with inflammatory bowel disease

作　　者：徐仁应[1] 周一泉[1] 张晓敏[1] 王天蓉[2] 乔宇琪[2] 陈之琦[1] 陆丽萍[1] 李浩捷 万燕萍[1] Xu Renying Zhou Yiquan Zhang Xiaomin Wang Tianrong Qiao Yuqi Chen Zhiqi Lu Liping Li Haojie Wan Yanping(Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属仁济医院临床营养科,200127 [2]上海交通大学医学院附属仁济医院消化内科,200127

出　　处：《中华临床营养杂志》2017年第3期141-146,共6页Chinese Journal of Clinical Nutrition

基　　金：雅培基金会项目（AFINS-HOPE-2013-06）;上海交通大学医学院附属仁济医院种子基金项目（RJZZ13-019）

摘　　要：目的 评估全肠外营养（TPN）对炎症性肠病（IBD）患者营养状况和炎症指标的影响.方法 回顾性分析2013年1月至2015年9月于上海交通大学医学院附属仁济医院消化内科 82例住院输注TPN的全禁食IBD患者,其中男性58例、女性24例,年龄（39.4±14.5）岁,溃疡性结肠炎（UC）38例、克罗恩病（CD）44例.收集患者临床资料（性别、年龄、病程、既往史、激素、免疫抑制剂、抗生素应用）;TPN前后营养相关指标、生化指标（肝肾功能）、C-反应蛋白（CRP）和红细胞沉降率（ESR）.TPN供给热量为（4 437.3±1 199.1）kJ/d,氮量为（9.9±1.7）g/d,中位时间为15 d（7～54 d）.67例IBD患者接受含中低剂量谷氨酰胺的TPN支持（≥14 d 25例,0～14 d 42例）,15例IBD患者TPN方案中不含谷氨酰胺.依据体质量指数（BMI）和血清白蛋白评定患者营养状态.炎性指标的影响因素采用二项Logistic回归分析.结果 本组患者营养不足发生率为90.2％（74/82）.CD患者较UC患者病程长[84（3～288）个月 比24（1～324）个月,P〈0.001],BMI也明显降低[（15.6±1.8）kg/m2 比（19.1±3.5）kg/m2,P〈0.001].TPN 能够明显升高IBD患者的血清白蛋白[TPN前（28.7±6.6）g/L比TPN后（31.7±5.8）g/L,P〈0.001]和前白蛋白[TPN前（174.1±85.5）mg/L比TPN后（227.2±82.8）mg/L,P〈0.001]水平.结论 TPN能够升高全禁食IBD患者白蛋白和前白蛋白水平.输注中低剂量谷氨酰胺对炎症指标的影响有待前瞻性随机对照研究的结果来验证.Objective To evaluate the impact of total parenteral nutrition（TPN）on nutrition status and inflammatory markers in hospitalized fasted patients with inflammatory bowel disease（IBD）.Methods A retrospective study was performed and 82 hospitalized fasted IBD patients [male/female=58/24,（39.4±14.5）years] who received TPN entered the study.Among them,38 patients had ulcerative colitis（UC）and 44 patients suffered from Crohn＇s disease（CD）.Clinical data（gender,age,duration of disease,history of disease,prednisone,immuno-suppressor,and antibiotics）were obtained from medical records.Nutritional parameters,C-creative protein（CRP）,and erythrocyte sedimentation rate（ESR）before and after TPN were also obtained.Average caloric supplementation by TPN was（4 437.3±1 199.1）kJ/d and the nitrogen amount was（9.9±1.7）g/d.Median PN length was 15 days（7-54 days）.67 IBD patients received a TPN formula with glutamine（≥14 d,25 patients vs.0-14 d,42 patients）and 15 IBD subjects received TPN without glutamine.Malnutrition was diagnosed by body mass index（BMI）and serum albumin level.Results The prevalence of undernutrition was 90.2%（74/82）in the study population.CD patients had a significantly longer history of disease [84（3-288）months vs.24（1-324）months,P〈0.001] and a significantly lower BMI [（15.6±1.8）kg/m2 vs.（19.1±3.5）kg/m2,P〈0.001] compared with those in UC patients.TPN improved nutritional parameters [serum albumin：（28.7±6.6）g/L before TPN vs.（31.7±5.8）g/L after TPN,P〈0.001;pre-albumin：（174.1±85.5）mg/L before TPN vs.（227.2±82.8）mg/L after TPN,P〈0.001].Conclusions TPN improves nutritional status in hospitalized fasted IBD patients.However,prospective randomized controlled trials are required to estimate the role of low-to-middle dosage of glutamine in IBD patients.

关 键 词：炎症性肠病 克罗恩病 溃疡性结肠炎 谷氨酰胺 全肠外营养 

分 类 号：R459.3[医药卫生—治疗学]