丙氨酰-谷氨酰胺强化肠外营养对结肠癌合并肠梗阻患者炎症反应及免疫功能的调节作用
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摘要
目的探讨丙氨酰-谷氨酰胺强化肠外营养对结肠癌合并肠梗阻患者炎症反应及免疫功能的影响。方法选取100例结肠癌合并肠梗阻患者,分为观察组和对照组,每组50例。对照组仅给予标准肠外营养,观察组加用丙氨酰-谷氨酰胺100ml/d。比较两组手术前后血清前白蛋白、白蛋白、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平。统计患者住院期间并发症发生率。结果术前及术后3 d,两组患者血清前白蛋白、白蛋白、IgA、IgG、IgM、TNF-α、IL-6水平比较,差异无统计学意义(P>0.05);术后7 d,与对照组比较,观察组患者血清前白蛋白、白蛋白、IgA、IgG、IgM水平增高(P<0.05),TNF-α、IL-6水平降低(P<0.05)。观察组并发症发生率低于对照组(4.0%vs 16.0%)(P<0.05)。结论结肠癌合并肠梗阻围手术期采用丙氨酰-谷氨酰胺强化肠外营养,可显著增强营养,提高机体免疫力,抑制炎症反应,降低感染率,其效果优于标准肠外营养。
Objective To evaluate the effect of alanyl-glutamine parenteral nutrition on inflammatory response and immunological function in patients with colon cancer and intestinal obstruction. Methods One hundred patients with colon cancer and intestinal obstruction were divided into observation group and control group with 50 in each group. The control group was given norm parenteral nutrition, and the observation group was given additional alanyl-glutamine(100 ml/d). The serum levels of prealbumin, albumin, IgA, IgG,IgM, tumor necrosis factor-α(TNF-α) and interleukin 6(IL-6) were compared between the two groups. The complication rate of the patients during hospitalization was calculated. Results The serum levels of prealbumin, albumin, IgA, IgG, IgM, TNF-α and IL-6 of the two groups were not statistically different before operation and 3 d after operation(P > 0.05). Compared with the control group, the serum levels of prealbumin, albumin, IgA, IgG and IgM of the observation group significantly increased(P < 0.05), and the TNF-α and IL-6levels of the observation group significantly decreased(P < 0.05) on the 7th d after operation. The complication rate of the observation group was significantly lower than that of the control group(4.0% vs 16.0%, P < 0.05).Conclusions Alanyl-glutamine parenteral nutrition used during the perioperative period in patients with colon cancer and intestinal obstruction can significantly enhance nutrition, improve body immunity, restrain inflammation and reduce infection rate. Its effect is better than that of the standard parenteral nutrition.
Objective To evaluate the effect of alanyl-glutamine parenteral nutrition on inflammatory response and immunological function in patients with colon cancer and intestinal obstruction. Methods One hundred patients with colon cancer and intestinal obstruction were divided into observation group and control group with 50 in each group. The control group was given norm parenteral nutrition, and the observation group was given additional alanyl-glutamine(100 ml/d). The serum levels of prealbumin, albumin, IgA, IgG,IgM, tumor necrosis factor-α(TNF-α) and interleukin 6(IL-6) were compared between the two groups. The complication rate of the patients during hospitalization was calculated. Results The serum levels of prealbumin, albumin, IgA, IgG, IgM, TNF-α and IL-6 of the two groups were not statistically different before operation and 3 d after operation(P > 0.05). Compared with the control group, the serum levels of prealbumin, albumin, IgA, IgG and IgM of the observation group significantly increased(P < 0.05), and the TNF-α and IL-6levels of the observation group significantly decreased(P < 0.05) on the 7th d after operation. The complication rate of the observation group was significantly lower than that of the control group(4.0% vs 16.0%, P < 0.05).Conclusions Alanyl-glutamine parenteral nutrition used during the perioperative period in patients with colon cancer and intestinal obstruction can significantly enhance nutrition, improve body immunity, restrain inflammation and reduce infection rate. Its effect is better than that of the standard parenteral nutrition.
引文
[1]胡月华.结肠支架对结肠癌并发肠梗阻患者炎症因子水平的影响[J].中国老年学杂志,2013,32(22):5746-5747.
[2]顾新华,谭纪伏,沈韧斌,等.支架联合肠内营养对左半结肠癌梗阻手术治疗的影响(附26例分析)[J].临床外科杂志,2013,20(12):901.
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[4]张晓勇.老年结肠癌患者术后的肠内肠外营养支持[J].中国老年学杂志,2011,31(9):1669-1670.
[5]杨洋,李良庆.丙氨酰-谷氨酰胺强化肠外营养在结肠癌合并肠梗阻治疗中的应用[J].广东医学,2011,32(17):2334-2335.
[6]王忱,林旭明,谢爱国.肠外营养用于老年梗阻性左半结肠癌术后吻合口瘘的预防[J].肠外与肠内营养,2006,13(5):308-311.
[7]张维丰.联合加用丙氨酰谷氨酰胺的肠外营养对胃肠癌患者术后营养及免疫功能的影响[J].中国临床药理学杂志,2012,28(12):947-949.
[8]黄春珍,王芳,许梦玫,等.丙氨酰谷氨酰胺在食管癌术后的应用与护理[J].世界华人消化杂志,2013,21(26):2698-2701.
[9]赵艳茹,周钰,刘波,等.谷氨酰胺强化营养支持对老年胃肠手术后免疫功能及肠黏膜通透性的作用[J].实用医学杂志,2013,28(23):3953-3955.
[10]黄汉飞,段键,徐王刚,等.添加谷氨酰胺和精氨酸的强化肠外营养液在肝移植病人术后的应用[J].肠外与肠内营养,2013,20(5):267-269.
[11]韩海燕.丙氨酰-谷氨酰胺对危重症患者肠屏障功能及免疫功能的影响研究[J].中国全科医学,2013,16(14):1607-1609.
[12]赵岩,张楚辞,郑国良,等.添加丙氨酰谷氨酰胺的胃肠外营养对存在营养风险的胃癌根治术患者免疫功能,营养状态及术后恢复的临床意义[J].现代生物医学进展,2012,12(19):3693-3697.
[13]赵劲松,廖克龙,杨康,等.丙氨酰谷氨酰胺注射液对食管癌患者术后营养和免疫状况的影响[J].中国临床营养杂志,2007,15(6):347-350.
[14]王海之,江志伟,汪志明,等.结直肠癌病人应用加速康复外科术后炎症反应和免疫功能的变化[J].肠外与肠内营养,2009,16(4):195-196.
[15]吴晓尉,郭美霞,王彬,等.丙氨酰谷氨酰胺对老年肠梗阻急性炎症反应和免疫功能的影响[J].临床和实验医学杂志,2013,12(15):1207-1208.
[2]顾新华,谭纪伏,沈韧斌,等.支架联合肠内营养对左半结肠癌梗阻手术治疗的影响(附26例分析)[J].临床外科杂志,2013,20(12):901.
[3]郑信志.早期肠内外营养联合应用在结肠癌术后的效果观察[J].中国肛肠病杂志,2013,32(11):18-20.
[4]张晓勇.老年结肠癌患者术后的肠内肠外营养支持[J].中国老年学杂志,2011,31(9):1669-1670.
[5]杨洋,李良庆.丙氨酰-谷氨酰胺强化肠外营养在结肠癌合并肠梗阻治疗中的应用[J].广东医学,2011,32(17):2334-2335.
[6]王忱,林旭明,谢爱国.肠外营养用于老年梗阻性左半结肠癌术后吻合口瘘的预防[J].肠外与肠内营养,2006,13(5):308-311.
[7]张维丰.联合加用丙氨酰谷氨酰胺的肠外营养对胃肠癌患者术后营养及免疫功能的影响[J].中国临床药理学杂志,2012,28(12):947-949.
[8]黄春珍,王芳,许梦玫,等.丙氨酰谷氨酰胺在食管癌术后的应用与护理[J].世界华人消化杂志,2013,21(26):2698-2701.
[9]赵艳茹,周钰,刘波,等.谷氨酰胺强化营养支持对老年胃肠手术后免疫功能及肠黏膜通透性的作用[J].实用医学杂志,2013,28(23):3953-3955.
[10]黄汉飞,段键,徐王刚,等.添加谷氨酰胺和精氨酸的强化肠外营养液在肝移植病人术后的应用[J].肠外与肠内营养,2013,20(5):267-269.
[11]韩海燕.丙氨酰-谷氨酰胺对危重症患者肠屏障功能及免疫功能的影响研究[J].中国全科医学,2013,16(14):1607-1609.
[12]赵岩,张楚辞,郑国良,等.添加丙氨酰谷氨酰胺的胃肠外营养对存在营养风险的胃癌根治术患者免疫功能,营养状态及术后恢复的临床意义[J].现代生物医学进展,2012,12(19):3693-3697.
[13]赵劲松,廖克龙,杨康,等.丙氨酰谷氨酰胺注射液对食管癌患者术后营养和免疫状况的影响[J].中国临床营养杂志,2007,15(6):347-350.
[14]王海之,江志伟,汪志明,等.结直肠癌病人应用加速康复外科术后炎症反应和免疫功能的变化[J].肠外与肠内营养,2009,16(4):195-196.
[15]吴晓尉,郭美霞,王彬,等.丙氨酰谷氨酰胺对老年肠梗阻急性炎症反应和免疫功能的影响[J].临床和实验医学杂志,2013,12(15):1207-1208.