谷氨酰胺双肽在异基因外周造血干细胞移植中的临床应用

Clinical Application of L-glutamine in Allogeneic Peripheral Blood Stem Cell Transplantation

目的研究谷氨酰胺双肽(Gln)在异基因外周造血干细胞移植(Allo-PBSCT)中的作用。方法将24例进行Allo-PBSCT的血液系统肿瘤患者分为标准化胃肠外营养液组(标准组,n=13)和加用Gln双肽的胃肠外营养液组(Gln组,n=11),造血干细胞输注后第1天开始给予胃肠外营养。结果两组患者营养物质的摄入基本相同,Gln组有3人发生粘膜炎,标准组有8人,两组相比差异有显著性(P<0.05);Gln组有1人发生严重腹泻,标准组有4人,两组相比差异有显著性(P<0.05);Gln组有1人发生临床感染,标准组有4人,两组相比差异有显著性(P<0.05);标准组中性粒细胞(ANC)≥0.5×109/L的时间为(13.9±3.4)d,Gln组为(13.9±3.3)d,两组相比差异有显著性(P>0.05);Gln组抗生素治疗时间为(12.2±2.1)d,标准组为(15.3±2.6)d,两组相比差异有显著性(P<0.05);Gln组住无菌病房时间缩短[(29.7±1.3)dvs(33.1±2.6)d,P<0.05]。结论两组患者中性粒细胞移植成功的时间无差异,但Gln能减少粘膜炎、严重腹泻和临床感染的发生率,缩短抗生素治疗时间及住无菌病房的时间。

Objective To study the effect of L-glutamine(Gln)on allogeneic peripheral blood stem cell tran-splantation(Allo-PBSCT). Methods Twenty-four patients receiving Allo-PBSCT for hematologic malig-nancies were divided into two groups: the group of standard total parenteral nutrition(standard group,n = 13)and the group of standard total parenteral nutrition with Gln(Gln group,n = 11). Parenteral nutrition was initiated at the day after peripheral blood stem cell transplantation(day 1). ResultsNutrient intake was similar in both groups. Three patients in the Gln group developed mucositis with 8 cases in the standard group(P < 0.05). One patients in the Gln group and 4 patients in the standard group developed severe diarrhea(P < 0.05). Four patients in the standard group developed clinical infection,however,only 1 case in the Gln group did so(P < 0.05). The time to reach > 0.5×109/L neutrophils was(13.9 ± 3.4)days in the standard group and(13.9 ± 3.3)days in the Gln group(P > 0.05). The time of antibiotic requirements was(15.3 ± 2.6)days in the standard group and(12.2 ± 2.1)days in the Gln group(P < 0.05). Free-germ ward stay was shortened in the Gln group?眼(29.7 ± 1.3)days vs(33.1 ± 2.6)days,P < 0.05?演. Conclusions Time to neutrophil engraftment is similiar between these two groups. L-glutamine can decrease the incidence of mucositis,severe diarrhea,and clinical infections. Meanwhile,L-glutamine can also shorten free-germ ward stay and reduce antibiotic requirements.