丙氨酰谷氨酰胺注射液对外科重症患者代谢的影响研究
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摘要
目的观察丙氨酰谷氨酰胺注射液对患者营养代谢、免疫功能及临床结局的影响。方法本文采用随机(1∶1∶1)、平行对照试验,将需要肠外补充营养的外科重症患者(≥18岁)按丙氨酰谷氨酰胺注射液剂量分为高剂量组、低剂量组和对照组进行疗效研究。结果第7日(D7)丙氨酰谷氨酰胺注射液高、低剂量组前白蛋白及转铁蛋白水平明显优于对照组(P <0.05),差异有统计学意义;治疗组感染性并发症、ICU住院时间及呼吸机使用时间均低于对照组(P <0.05),差异有统计学意义;与低剂量组比较,高剂量组差异无统计学意义(P> 0.05);与对照组比较,高剂量组死亡率低于对照组,差异有统计学意义(P <0.05);低剂量组死亡率低于对照组,但差异无统计学意义(P> 0.05);3组间非感染性并发症差别无统计学意义(P> 0.05)。结论肠外营养中添加丙氨酰谷氨酰胺注射液有助于降低外科重症患者感染性并发症和ICU住院时间,添加高剂量丙氨酰谷氨酰胺双肽制剂可能有助于降低患者的死亡率;有助于增加外科重症患者支链氨基酸含量,改善蛋白质代谢,提高血浆蛋白水平,添加高剂量可能效果更佳;有助于降低外科重症患者炎症反应,提高机体细胞免疫水平。
Objective To observe the effect of alanyl glutamine injection on the nutritional metabolism, immune function and clinical outcome in patients. Methods A randomized(1 ∶ 1 ∶ 1) and parallel controlled trial was conducted to determine the efficacy of severe surgical patients(over 18 years old) requiring extrenteral nutrition in a high-dose group, a low-dose group, and the control group according to the acrylamide injection. Results On day 7, the prealbumin and transferrin levels of the treatment group were significantly higher than those of the control group(P < 0.05). The ICU infection complications, hospitalization time and ventilation time of the treatment group were significantly lower or shorter than those of the control group(P < 0.05), with no significant difference between the high dose group and the low dose group(P > 0.05). Compared with that of the control group, the mortality of the high dose group was significantly lower(P < 0.05); and that of the low dose group was lower than, but no significant difference(P > 0.05). The infection complications among the three groups had no significant difference(P > 0.05). Conclusion Parenteral nutrition with glutamine helps reduce severe infection complications and ICU hospitalization time in surgerical patients. Addition of high dose of glutamine(Gln) dipeptide preparation helps reduce the patient mortality; increase branched chain amino acids in critically ill surgical patients, improve protein metabolism and the level of plasma protein with better effect. It also helps reduce severe inflammatory reaction and enhance cellular immunity level in surgical patients.
Objective To observe the effect of alanyl glutamine injection on the nutritional metabolism, immune function and clinical outcome in patients. Methods A randomized(1 ∶ 1 ∶ 1) and parallel controlled trial was conducted to determine the efficacy of severe surgical patients(over 18 years old) requiring extrenteral nutrition in a high-dose group, a low-dose group, and the control group according to the acrylamide injection. Results On day 7, the prealbumin and transferrin levels of the treatment group were significantly higher than those of the control group(P < 0.05). The ICU infection complications, hospitalization time and ventilation time of the treatment group were significantly lower or shorter than those of the control group(P < 0.05), with no significant difference between the high dose group and the low dose group(P > 0.05). Compared with that of the control group, the mortality of the high dose group was significantly lower(P < 0.05); and that of the low dose group was lower than, but no significant difference(P > 0.05). The infection complications among the three groups had no significant difference(P > 0.05). Conclusion Parenteral nutrition with glutamine helps reduce severe infection complications and ICU hospitalization time in surgerical patients. Addition of high dose of glutamine(Gln) dipeptide preparation helps reduce the patient mortality; increase branched chain amino acids in critically ill surgical patients, improve protein metabolism and the level of plasma protein with better effect. It also helps reduce severe inflammatory reaction and enhance cellular immunity level in surgical patients.
引文
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[2]Hequesm,Chenk,Usuin,et al. Alanyl-glutamine dipeptide-supplemented paranteral nutrition improves intestinal metabolism and prevents increased permeability in rats[J].Ann Surg,1996,233(3):334-341.
[3]Jackson NC,Carroll PV,Russelljones DL,et al. The metabolic consequences of critical illness:acute effects on glutamine and protein metabolism[J]. Am J Physiol,1999,276(1 Pt 1):E163-E170.
[4]Rohde T,Krzywkowski K,Pedersen BK. Glutamine,exercise,and the immune system——is there a link?[J].Exerc Immunol Rev,1998,4:49-63
[5]楼正亮,查育新.肠外营养加用丙氨酰谷氨酰胺注射液对食管癌患者术后营养状态及免疫功能的影响[J].中国医院药学杂志,2010,30(2):149-152.
[6]张万红,苏长春.国内谷氨酰胺强化的肠外营养对胃癌患者免疫功能影响的meta分析[J].中华普通外科学,2011,5(4):343-346.
[7]叶吉云,黄洁,田大广.丙氨酰原谷氨酰胺双肽对外科危重患者术后免疫功能的临床研究[J].昆明医学院学报,2010,31(6):93-95.
[8]Abe T,Hosoi T,Kawai R,et al. Perioperative enteral supplementation with glutamine,fiber,and oligosaccharide reduces early postoperative surgical stress following esophagectomyforesophagealcancer[J].Esophagus,2018,doi:10.1007/s10388-018-0630-z.
[9]Joo E,Yamane S,Hamasaki A,et al. Enteral supplement enriched with glutamine,fiber,and oligosaccharide attenuates experimental colitis in mice[J] Nutrition,2013,29(3):549-555.
[10]Pérez-Bárcena J,CrespíC,Regueiro V,et al. Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit[J]. Critical Care,2010,14(6):R233.
[2]Hequesm,Chenk,Usuin,et al. Alanyl-glutamine dipeptide-supplemented paranteral nutrition improves intestinal metabolism and prevents increased permeability in rats[J].Ann Surg,1996,233(3):334-341.
[3]Jackson NC,Carroll PV,Russelljones DL,et al. The metabolic consequences of critical illness:acute effects on glutamine and protein metabolism[J]. Am J Physiol,1999,276(1 Pt 1):E163-E170.
[4]Rohde T,Krzywkowski K,Pedersen BK. Glutamine,exercise,and the immune system——is there a link?[J].Exerc Immunol Rev,1998,4:49-63
[5]楼正亮,查育新.肠外营养加用丙氨酰谷氨酰胺注射液对食管癌患者术后营养状态及免疫功能的影响[J].中国医院药学杂志,2010,30(2):149-152.
[6]张万红,苏长春.国内谷氨酰胺强化的肠外营养对胃癌患者免疫功能影响的meta分析[J].中华普通外科学,2011,5(4):343-346.
[7]叶吉云,黄洁,田大广.丙氨酰原谷氨酰胺双肽对外科危重患者术后免疫功能的临床研究[J].昆明医学院学报,2010,31(6):93-95.
[8]Abe T,Hosoi T,Kawai R,et al. Perioperative enteral supplementation with glutamine,fiber,and oligosaccharide reduces early postoperative surgical stress following esophagectomyforesophagealcancer[J].Esophagus,2018,doi:10.1007/s10388-018-0630-z.
[9]Joo E,Yamane S,Hamasaki A,et al. Enteral supplement enriched with glutamine,fiber,and oligosaccharide attenuates experimental colitis in mice[J] Nutrition,2013,29(3):549-555.
[10]Pérez-Bárcena J,CrespíC,Regueiro V,et al. Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit[J]. Critical Care,2010,14(6):R233.
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