精氨酸强化的肠外营养在肝癌合并肝硬化术后的应用

The Postoperative Use of L-arginine Enriched Parenteral Nutrition in Hepatocellular Carcinoma and Cirrhosis Patients

目的探讨精氨酸(L-Arginine)强化的肠外营养(parenteralnutrition熏PN)在原发性肝癌(hepatocellularcarcinoma,HCC)合并肝硬化患者术后的应用价值。方法70例行肝段或肝叶切除手术的患者,随机分为2组:对照组(给予PN)35例,实验组(给予精氨酸强化的PN,Arg-PN)35例。观察患者术前、术后1d及7d肝功能、营养指标、免疫功能及血清一氧化氮(nitricoxide熏NO)浓度变化。结果两组患者平均住院时间、并发症发生率的差异无显著意义(P>0.05);与术前比较,实验组术后第7天肝天冬氨酸转氨酶(AST)、总胆红素(TBIL)已接近术前水平,血清白蛋白(ALB)明显降低(P<0.05);实验组术后胰岛素样生长因子(IGF-1)和NO浓度与术前及对照组比较,均明显上升(P<0.05);实验组术后CD4升高、CD8下降、CD4/CD8比值升高,与术前比较差异均有显著性(P<0.05)。结论精氨酸强化的肠外营养有可能通过Arg-NO代谢途径增加NO浓度,促进IGF-1产生,有利于肝癌肝硬化患者术后肝功能恢复和改善营养状况,增强细胞免疫功能。

Objective To study the postoperative effects of L-arginine enriched parenteral nutrition in hepatoce-llular carcinoma and cirrhosis patients.Methods Seventy hepatocellular carcinoma and cirrhosis patients who were waiting for operation were randomly divided into two groups:control group(PN),parenteral nutrition only(n=35);and Arg-PN group,parenteral nutrition supplemented with arginine(n=35).The liver function,nutritional and immunological indices,and serum nitric oxide(NO)level were investigated respectively on two or three time points:preoperative phase,postoperative day1(POD1)and postopera-tive day7(POD7).Results The average hospitalization time and complications of two groups were not significant.In Arg-PN group,compared with preoperative,AST and TBIL levels decreased near the preoperative level on POD7,and ALB level also significanly decreased.IGF-1and NO levels were significantly higher than their preoperative levels and those of control group.CD4and CD4/CD8ratio significantly increased and CD8level significantly decreased in Arg-PN group on POD7compared with preoperative.Conclusions Arginine can produce NO through L-Arg-NO pathway.Supplement of appropriate amounts of L-arginine may increase NO and IGF-1levels,promote the postoperative recovery of liverfunction,improve the nutritional status,ameliorate cell-mediated immunofunction.