早期应用谷氨酰胺治疗对老年结直肠癌病人术后胰岛素抵抗和炎性因子的影响  

Effect of early glutamine treatment on postoperative insulin resistance and inflammatory factors in elderly patients with colorectal cancer

作　　者：陈伟 梁永强[1] 汤献忠[1] 李兴谦[1] 谢就坤 CHEN Wei;LIANG Yongqiang;TANG Xianzhong;LI Xingqian;XIE Jiukun(Department of Anoenterology,The People's Hospital of Dongguan,Dongguan,Guangdong 523039,China)

机构地区：[1]东莞市人民医院肛肠科,广东东莞523039

出　　处：《安徽医药》2022年第2期409-412,共4页Anhui Medical and Pharmaceutical Journal

基　　金：东莞市科技发展项目(201650715001399)。

摘　　要：目的探讨早期应用谷氨酰胺治疗对老年结直肠癌病人营养指标、术后胰岛素抵抗(IR)、炎性因子和并发症的影响。方法收集2018年1月至2019年12月东莞市人民医院90例老年结直肠癌病人作为观察对象,采用随机数字表法分为对照组和观察组,每组各45例。所有病人均接受手术治疗。术后,对照组给予常规早期肠内营养治疗,观察组在对照组基础上早期给予谷氨酰胺治疗。比较两组病人手术前后营养指标、IR指标、炎性因子水平及术后并发症发生率。结果术后1周,观察组病人总蛋白[(72.70±8.53)g/L比(68.29±8.24)g/L]、前白蛋白[(214.79±23.06)mg/L比(182.51±29.58)mg/L]和白蛋白[(38.19±6.72)g/L比(34.65±6.20)g/L]等营养指标水平均高于对照组(P<0.05)。术后3 d,与对照组相比,观察组空腹血糖(FBG)[(6.47±1.02)mmol/L比(7.01±1.22)mmol/L]、空腹胰岛素(FINS)[(10.71±2.04)μU/mL比(14.23±2.46)μU/mL]、HOMA-IR[(3.26±0.75)比(1.52±0.23)]等IR指标水平降低,肿瘤坏死因子α(TNF-α)[(51.08±4.36)ng/L比(71.49±5.20)ng/L]、白细胞介素6(IL-6)[(17.42±3.95)ng/L比(20.27±4.51)ng/L]、C反应蛋白(CRP)[(9.81±2.20)mg/L比(13.53±3.02)mg/L]等炎性因子水平降低(P<0.05)。且观察组病人术后并发症发生率低于对照组(6.7%比22.2%),差异有统计学意义(P<0.05)。结论对于老年结直肠癌术后病人,早期应用谷氨酰胺治疗能够在改善营养状况的同时,有效减轻术后IR和炎性反应,并减少术后并发症发生。Objective To investigate the effect of early glutamine treatment on nutrition indices,postoperative insulin resistance(IR),inflammatory factors and complications in elderly patients with colorectal cancer.Methods A total of 90 elderly patients with colorectal cancer in Dongguan People's Hospital from January 2018 to December 2019 were collected as observational objects,and were divided into control group and observation group by random number table method,with 45 cases in each group.All patients received operation therapy.After operation,the control group was given conventional early enteral nutrition treatment,and the observation group was given early glutamine treatment on the basis of the control group.Levels of nutrition indices,IR indices,inflammatory factors before and after operation and incidence of postoperative complications were compared.Results One week after operation,nutrition indices of total protein[(72.70±8.53)g/L vs.(68.29±8.24)g/L],prealbumin[(214.79±23.06)mg/L vs.(182.51±29.58)mg/L]and albumin[(38.19±6.72)g/L vs.(34.65±6.20)g/L]in the observation group were higher than those in the control group(all P<0.05).Three days after operation,in comparison with the control group,the observation group had lower levels of IR indices of fasting blood glucose(FBG)[(6.47±1.02)mmol/L vs.(7.01±1.22)mmol/L],fasting insulin(FINS)[(10.71±2.04)μU/mL vs.(14.23±2.46)μU/mL],HOMA-IR[(3.26±0.75)vs.(1.52±0.23)]and lower levels of inflammatory factors of tumor necrosis factorα(TNF-α)[(51.08±4.36)ng/L vs.(71.49±5.20)ng/L],interleukin 6(IL-6)[(17.42±3.95)ng/L vs.(20.27±4.51)ng/L],C-reactive protein(CRP)[(9.81±2.20)mg/L vs.(13.53±3.02)mg/L]with all statistical differences(all P<0.05).Conclusion For elderly patients with colorectal cancer who receives operation therapy,early glutamine treatment can not only improve nutritional status,but also effectively alleviate postoperative IR and inflammatory reaction with reduced postoperative complications.

关 键 词：谷氨酰胺 手术后期间 老年人 结直肠癌 营养 胰岛素抵抗 炎性因子 

分 类 号：R735.34[医药卫生—肿瘤]