丙氨酰-谷氨酰胺强化营养支持对肠梗阻患者的效果  

Effect of alanyl glutamine intensive nutritional support in patients with intestinal obstruction

作　　者：黄振范 何琳 黄月朝 陈颜 谢景泉 祝柏森 HUANG Zhenfan;HE Lin;HUANG Yuezhao;CHEN Yan;XIE Jingquan;ZHU Bosen(Department of Gastrointestinal and Anal Surgery,the Second Affiliated Hospital of Guangdong Medical University,Zhanjiang 524003,China;Department of Gastroenterology,the Second Affiliated Hospital of Guangdong Medical University,Zhanjiang 524003,China;Department of Internal Oncology,the Second Affiliated Hospital of Guangdong Medical University,Zhanjiang 524003,China)

机构地区：[1]广东医科大学附属第二医院胃肠肛门外科,湛江524003 [2]广东医科大学附属第二医院消化内科,湛江524003 [3]广东医科大学附属第二医院肿瘤内科,湛江524003

出　　处：《西北药学杂志》2023年第5期130-134,共5页Northwest Pharmaceutical Journal

基　　金：湛江市科技计划项目(编号:2020B01441)。

摘　　要：目的探讨丙氨酰-谷氨酰胺强化营养支持对肠梗阻患者辅助性T细胞1(help T cell 1,Th1)/辅助性T细胞2(help T cell 2,Th2)值及体内微炎症状态的影响。方法选取肠梗阻患者91例,用简单随机数字表法分为研究组(n=46)与对照组(n=45)。对照组采取肠外营养支持,研究组在对照组治疗的基础上加用丙氨酰-谷氨酰胺。统计2组治疗前、后营养状态指标[转铁蛋白(transferrin,TF)、前白蛋白(prealbumin,PA)、白蛋白(albumin,ALB)]的水平、微炎症指标[白细胞介素-6(interleukin-6,IL-6)、高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]的水平、肠道屏障生化指标(二胺氧化酶、D-乳酸)水平和Th1/Th2值。结果研究组禁食及禁水时间、排气及排便时间、腹胀及腹痛缓解时间均短于对照组(P<0.05)。治疗3、7 d后,2组患者血清TF、ALB和PA的水平均增高,且研究组高于对照组(P<0.05);IL-6、hs-CRP和TNF-α的水平均降低,且研究组低于对照组(P<0.05);血清二胺氧化酶、D-乳酸的水平降低,且研究组低于对照组(P<0.05);Th1/Th2值增高,且研究组高于对照组(P<0.05)。结论采取丙氨酰-谷氨酰胺强化营养支持可改善肠梗阻患者的免疫状态和营养状态,减轻体内微炎症反应,恢复肠道屏障功能,缩短功能康复时间。Objective To investigate the effect of alanyl glutamine intensive nutritional support on helper T cell 1(Th1)/helper T cell 2(Th2)and micro inflammation in patients with intestinal obstruction.Methods 91 patients with intestinal obstruction were randomly divided into the study group(n=46)and the control group(n=45).The control group took parenteral nutrition su-pport and the study group took alanyl-glutamine based on the control group.The nutritional status indexes[transferrin(TF),prealbumin(PA),albumin(ALB)],the micro inflammatory indexes[interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factorα(TNF-α)],the intestinal barrier biochemical indexes(diamine oxidase,D-lactic acid)and Th1/Th2 before and after treatment were detected and compared between the 2 groups.Results The fasting time,exhaust and defecation time,the abdominal distension and abdominal pain relief time in the study group were shorter than those in the control group(P<0.05).After 3 and 7 days treatment,the serum TF,ALB and PA in the 2 groups increased.The serum TF,ALB and PA in the study group were higher than those in the control group(P<0.05).The serum IL-6,hs-CRP and TNF-αin the 2 groups decreased.The serum IL-6,hs-CRP and TNF-αin the study group were lower than those in the control group(P<0.05).The serum diamine oxidase and D-lactate in the 2 groups decreased.The serum diamine oxidase and D-lactate in the study group lower than in the control group(P<0.05).The Th1/Th2 in the 2 groups increased.The Th1/Th2 in the study group was higher than in the control group(P<0.05).Conclusion For patients with intestinal obstruction,taking alanyl glutamine intensive nutritional support can improve the immune status and nutritional status,reduce the micro-inflammatory reaction,restore the intestinal barrier function and shorten the time for functional rehabilitation.

关 键 词：丙氨酰-谷氨酰胺 营养支持 肠梗阻 辅助性T细胞1/辅助性T细胞2 微炎症状态 

分 类 号：R975[医药卫生—药品]