丙氨酰谷氨酰胺对合并肝硬化结直肠癌患者术后蛋白质代谢及营养状况的影响

Effect of total parenteral alimentation nutrition supplemented with alanyl-glutamine on metabolism of protein and nutrition states in patients with cirrhosis after colorectal radical correction

目的探讨传统全肠外营养(total parenteral nutrition,TPN)及添加丙氨酰谷氨酰胺(alanyl-glutamine,Ala-Gln)的TPN对合并肝硬化结直肠癌患者术后蛋白质代谢及营养状况的影响。方法将47例合并肝硬化结直肠癌患者前瞻性地随机分为两组:传统TPN组(对照组,22例),添加Ala-Gln的TPN组(研究组)。术后第2天按照标准体质量,给予静脉营养支持,共7 d,热量为104.6 kJ/kg,对照组氮源由支链氨基酸供给,研究组氮源由支链氨基酸和Ala-Gln(20%力肽),力肽提供氮量约占总氮量的35%。术后第2天和第10天测量:肱三头肌皮皱厚度(triceps skin-fold,TSF)、上臂中部肌周长(mid-armcircumference,MAC)、营养预后指数(prognostic nutritional index,PNI)、血清总蛋白(total serum protein,TSP)、血清白蛋白(serum albumin,SA)、前白蛋白(prealbumin,PA)和转铁蛋白(transferrin,TF)。结果对照组术后第10天较术后第2天的TSF和MAC明显降低(P<0.05),研究组无明显变化(P≥0.05);对照组术后第10天较术后第2天的PNI、PA和TF下降(P<0.05),研究组术后第10天和术后第2天的PNI、PA和TF明显增加(P<0.05)。结论TPN中添加Ala-Gln能有效减轻合并肝硬化结直肠癌根治术后机体蛋白质的分解,改善病人的蛋白质合成代谢和降低肝负荷。

Objective To investigate the effect of total parenteral nutrition（TPN ） supplemented with ala- nyl-glutamine（Ala-Gln） on metabolism of protein and nutrition state in patients with cirrhosis after colorectal radical correction. Methods Forty-seven cases with colorectal carcinoma complicated with liver cirrhosis were prospectively divided into control group （22 cases, infused with traditional TPN） and research group （25 cases, infused with TPN supplemented with Ala-Gln） in random. The patients were given nutrition 2 days after radical corrections for 7 days, calory for 25 kcal/Kg day, and nitrogen source was given with branched chain amino acid in control group and branched chain amino acid added with Ala-Gln in research group. Triceps skin-fold （ TSF ）, mid-arm circumference （ MAC ）, prognostic nutritional index （PNI）, total serum protein（TSP）, serum albumin（SA）, prealbumin（PA） and transferrin （TF） were examined 2 and 10 days after operation. Results TSF and MAC decreased significantly 10 days after operation in control group compared with that of 2 days（ P〈0.05）, but there was no marked change in research group（P≥0.05）. PNI, PA and TF increased significantly 10 days after operation in research group com- pared with that of 2 days（ P〈0.05）, but decresed significantly in control group（ P 〈0.05）. Conclusion TPN supplemented with Ala-Gln can attenuate catabolism of protein, improve anabolism of protein and cut down the load of liver.