肝移植后营养支持对蛋白质代谢及营养状况影响的探讨

Effects of nutrition surport on metabolism of protein and nutritional statusin patients undergoing liver transplantation

目的:探讨全肠外营养(TPN)、传统TPN及添加丙氨酰谷氨酰胺(Ala-Gln)的TPN对肝移植后机体蛋白质代谢及营养状况影响。方法:将35例肝移植患者随机分3组:术后未经TPN(饮食组)、不添加Ala-Gln的TPN组(传统组)、添加Ala-Gln的TPN组(二肽组)。TPN于术后第2天予以等热量(每千克体重104.6kJ)、等氮量(每千克体重0.16g)共7天。对术后第2天、术后第9天营养预后指数(PNI)、总蛋白(TP)、白蛋白(Alb)、前白蛋白(PAB)、转铁蛋白(TF)监测。结果:术后第9天比较于术后第2天,增高差异有显著性的有:所有组的Alb(P<0.05),传统组的PAB、TF及二肽组的PNI、PAB、TF(P<0.01);增高幅度大且差异有显著性的有:二肽组较饮食组及传统组的PNI(P<0.05),二肽组较饮食组的Alb(P<0.05),二肽组较饮食组及传统组的PAB(P<0.01),二肽组及传统组较饮食组的TF(P<0.01)。结论:肝移植术后TPN是必要的,而TPN中添加Ala-Gln能更好地改善蛋白质代谢和营养状况。

Objective： TO explore the effects of dipeptide-supplemented total prenteral nutrition （TPN） ,traditional TPN on the metabolism of protein and nutritional status in patients undergoing liver transplantation. Methods： Thirty-five patients were randomly divided into three groups： group one （diet group）, receiving common diet; group two （traditional group）, receiving TPN without Ala-Gln;group three （dipeptide group） ,receiving TPN with Ala-Gln. Patients in group two and group three received isocaloric [104.6 kJ/（kg＇d）] and isonitrogenous [0.16 g/（kg.d）]. TPN one day after the operation for seven days. Prognostic nutritional index（PNI）, total protein（TP）, albumin （Alb）, prealbumin （ PAB）,and transferrin （TF） were measured on the second day and the ninthday after transplantation respectively. Results： The indexes increased significantly on the ninth day campared to the second day, including Alb in all the groups （P 〈 0.05）, PAB and TF in traditional group （P 〈 0.05）, PNI,PAB and TF in dipeptide group （P 〈 0.01 ） ; PNI and PAB in group three were increaded more significantly compared with the other two groups（P 〈 0.05 and P 〈 0.01）, and Alb in group three was increased more significantly compared with group one（P 〈 0.05）,and TF in group two and group three was increaded more significantly compared with group one. Conclusion： TPN is necessary to the patients undergoing liver transplantation. TPN with Ala-Gln can greatly improve metabolism of protein and nutritional status compared with traditional TPN.