谷氨酰胺强化肠内营养对手术后患者脏器和免疫功能的影响  

The impact of alanyl-glutamine-enriched enteral nutrition on immune function of postoperative patients

作　　者：王宝贵[1] 蒋朱明[1] 王秀荣[1] 何桂珍[1] 杨乃发[1] 舒红[1] 崔巍[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院肠内肠外营养中心

出　　处：《中华胃肠外科杂志》2003年第4期270-273,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：卫生部重点项目基金(9701204)

摘　　要：目的观察谷氨酰胺强化肠内营养对手术后患者机体免疫功能的影响。方法将符合入选标准的32例消化道手术患者按随机表分别予以肠外营养(PN组)、基础型肠内营养(EN组)和谷氨酰胺强化肠内营养(GLN组)。3组患者术后第3天开始至术后第11天,接受等氮等热卡的营养支持(92.0kJ·kg-1·d-1,0.2gN·kg-1·d-1)。观察脏器功能、外周血淋巴细胞亚群、血清免疫球蛋白、血浆谷氨酰胺水平及预后指标。结果(1)PN组出现一过性肝功能损害的患者较其他2组为多,但差异无显著性(P=0.11～0.24);(2)PN组CD3+、CD4+细胞百分比以及CD4+/CD8+的比值术后第11天低于术前水平,且其手术前后的差值明显低于其他两组(P=0.04,0.001,0.006)。GLN组术后第11天与术前CD25+细胞百分比的差值明显高于PN组(P=0.01),比较EN组也有增高趋势(P=0.07);(3)术后第11天PN组患者血浆免疫球蛋白(IgG、IgM)明显低于术前水平(P=0.04,0.05),而其他两组已恢复到术前水平;(4)术后第11天,PN组患者血浆游离谷氨酰胺水平明显低于EN组和GLN组(P=0.001);(5)EN组的营养药费用明显低于PN组(P=0.001)。结论PN组患者有较多一过性肝功能损害。在本研究条件下,肠内营养支持后可减轻免疫功能抑制,谷氨酰胺强化后这种免疫功能得到加强。Objective To evaluate the impact of alanyl glutamine enriched enteral nutrition on immune function of postoperative patients. Methods Thirty two patients after major abdominal operation were randomly divided into three groups and received conventional parenteral nutrition(PN group), enteral nutrition (EN group) and alanyl glutamine enriched nutrition (GLN group) with isonitrogenic (0 2 g·kg-1·d-1) and isocarloric (92 0 kJ·kg-1·d-1) support from postoperative day(POD) 3 to POD11. The peripheral lymphocyte proportion and immunoglobin levels were measured. Results As compared with preoperative levels, the proportions of CD3+ and CD4+, and CD4+/CD8+ ratio on POD 11 decreased significantly in PN group (P=0.0003), but were resumed in both EN and GLN groups. The proportion of CD25+ was higher in GLN group than those of PN and EN groups(P=0.01,0.07). The plasma IgG and IgM on POD 11 in PN group were still significantly lower than preoperative levels(P=0.04), while in EN and GLN groups were resumed to the preoperative levels. Conclusions Enteral nutrition can alleviate the immunosuppression following the major abdominal operation, and glutamine enrichment can improve such immune function.

关 键 词：谷氨酰胺 肠内营养 脏器 免疫功能 肠外营养 手术后 胃肠肿瘤 

分 类 号：R459.3[医药卫生—治疗学]