谷氨酰胺对结直肠癌化疗患者肠屏障功能保护的临床研究

Protective effect of Glutamine on intestinal barrier function in patients of carcinoma of colon and rectum receiving chemotherapy

目的观察谷氨酰胺对结直肠癌术后化疗患者肠黏膜屏障的保护作用。方法将2004年1月～2006年1月期间结直肠癌根治术后在该院接受第4次化疗的51例患者分成观察组(25例)和对照组(26例),化疗方案为氟尿嘧啶(5-FU)、四氢叶酸(CF)加奥沙利,即FOLFOX方案。观察组化疗同时口服谷氨酰胺颗粒30粒/d,分3次服,连续7d;对照组仅接受化疗。检测两组患者接受第4次化疗前后血浆中谷氨酰胺浓度和尿中乳果糖/甘露醇(L/M)比值。结果观察组化疗后血浆中谷氨酰胺浓度明显高于对照组[(607.32±85.33)vs(517.67±61.46)]μmol/L(P<0.01);尿中L/M比值观察明显低于对照组[(0.0357±0.0046)vs(0.0514±0.0071)](P<0.01)。结论谷氨酰胺颗粒能够显著提高结直肠癌术后化疗患者血谷氨酰胺浓度,降低尿乳果糖/甘露醇比值(L/M比值),从而减轻化疗药物对肠黏膜损伤程度,有效维护肠黏膜屏障功能。

[Objective] To study the protective effect of Glutamine （Gin） on intestinal permeability in patients of carcinoma of colon and rectum receiving chemotherapy. [Methods] Sixty-one patients with carcinoma of colon and rectum after operation who accepted the fourth chemotherapy were randomly divided into Gin groups and control groups. The former received oral administration of Glutamine （30 g/d） for 7 days （n =25） and not （n =26）. All patients received CF＋5-FU＋Oxalipatin chemotherapy,namely FOLFOX formula, for 5 days. Serum concentration of glutamine and urinary Lactulose/Mannitol （L/M） ratio were measured before and 1 day after chemotherapy. [Results] After chemotherapy, the serum Gin concentration was significantly increased in the Gin group compared with the control group [（607.32±85.33） vs （517.67±61.46）] μmol/L, and there was significant difference between the two groups （P〈0.01）. Urine L/M ratio was significantly decreased in the Gin group compared with the control group [（0.0357±0.0046） vs （0.0514±0.0071）], and there was significant difference between the two groups after chemotherapy （P 〈0.01）. [Conclusion] Oral administration of Gintamine granules can increase serum concentration of Gintamine in chemothepapy patients with carcinoma of colon and rectum and can decrease intestinal permeability, main- rain intestinal barrier.