肝移植术后谷氨酰胺的应用

The application of Gln-glutamine in patients after liver transplantation

目的探讨传统全胃肠外营养(TPN)及添加丙氨酰谷氨酰胺(Gln,商品名力太)的TPN对肝移植后移植肝蛋白合成功能、机体免疫功能及对感染、排斥反应发生率的影响。方法将50例肝移植患者随机分两组:不添加Gln的TPN组(传统组)和添加Gln的TPN组(Gln组)。术后第2天予等热量〔104.6kJ/kg(体重)〕、等氮量〔0.16g/kg(体重)〕共7d。监测术后第2和9天IgG,IgA,IgM,CD3,CD4/CD8及前清蛋白(PAB)。结果术后第9天与术后第2天比较Gln组IgG和IgA较之传统组明显升高,组间比较P<0.01;Gln组应用前后比较P<0.01。Gln组CD3,CD4/CD8平均值较之传统组明显升高,组间比较P<0.01;Gln组应用前后比较P<0.05;Gln组感染率(20.0%)较之传统组(40.0%)明显降低(P<0.05);术后PBA增高幅度Gln组明显高于传统组(P<0.01);两组比较IgM变化及急性排斥反应差异无显著性。结论肝移植后静脉营养中添加Gln可增强免疫功能,尤以体液免疫增强为著,但并不增加急性排斥反应;使用Gln同时增加移植肝蛋白合成功能及降低感染发生率。

Objective To explore the effects of Gin- glutamine （ Gin- ） supplemented TPN and traditional TPN on immunofunction, incidence of both rate of acute rejection and infection, and protein synthesis function of transplantation liver. Methods Fifty patients with liver transplantation were randomly divided into two groups： group TPN without Gin- and group TPN with Gin-. Patients received isocaloric [ 104. 6 kJ / （kg · d）] and isonitrogenous [ （0. 16g/（ kg · d） ] TPN for seven days. IgG, IgA, IgM, CD3, CD4/ CD8, prealbumin （PAB） were monitored on the second and the ninth day after transplantation. Results IgG, IgA, CD3 , CD4 /CD8, PA levels of the group TPN with Gln- had significant elevation on the ninth day as compared to those on the second day after operation. The incidence rate of infection of the group TPN with Gin- was significantly lower than the group TPN without Gin-, while the incidence rate of acute rejection had no significant difference between the two groups. Conclusions Gln-glutamine supplemented TPN can enhance the immunofunction of patients after liver transplantation, stimulate protein synthesis function and lower the incidence rate of infection, and does not increase the incidence of acute rejection.