肠外营养加用丙氨酰谷氨酰胺注射液对食管癌患者术后营养状态及免疫功能的影响

Effect of alanyl glutamine added total parenteral nutrition (TPN) on nutrition status and immune function of patients after the operation of esophageal carcinoma

目的:探讨肠外营养(TPN)加丙胺酰谷氨酰胺注射液在临床上对食管癌患者术后营养及免疫能力改善的意义。方法:将88例食管癌患者随机等分为治疗组和对照组,均于术后给予7dTPN治疗,其中治疗组患者每天加用丙胺酰谷氨酰胺注射液0.4g.kg-1。检测患者术前、术后2d及7d的血清白蛋白(ALB)水平、血红蛋白(Hb)水平、预后营养指数PNI、各细胞及体液免疫指标,进行比较分析。结果:治疗组和对照组在治疗后2d,ALB、Hb水平及PNI均显著低于治疗前,差异有显著性(P<0.05或P<0.01);治疗后7d,对照组的PNI仍显著低于治疗前(P<0.05)。治疗组的ALB、Hb及PNI升高比对照组患者快,治疗7d,其ALB水平、PNI均显著高于对照组(P<0.05)。患者术后的各项细胞免疫指标及体液免疫指标都会出现下降,治疗7d,对照组的IgG仍显著低于治疗前(P<0.05),其他均基本恢复到治疗前;治疗组的IgA、IgG显著高于对照组(P<0.05)。结论:食管癌患者在术后TPN治疗基础上加用丙胺酰谷氨酰胺注射液更能有效改善机体营养和免疫状况,从而促进预后。

OBJECTIVE To explore the effect of alanyl glutamine added total parenteral nutrition （TPN） on patients＂ nutrition and immune function of patients after the operation of esophageal carcinoma. METHODS 88 patients were divided into treatment group and control group randomly. All patients underwent TPN for 7 d after the operation. Injection of alanyl gluta- mine was given to the treatment group with a dose of 0. 4 g· kg-1. The level of albumin （ALB）, hemoglobin （ Hb）, prognostic nutritional index （PNI）, index of cellular immunity and humoral immunity were determined and compared with that of pre-oper- ation,2 d and 7 d after operation. RESULTS The level of ALB, Hb and PNI of both groups 2 d after operation were all signifi- cantly lower than that before operation with statistic significance （P〈0. 05 or P〈0. 01）. PNI of control group was still lower than that before operation with statistic significance （P〈0. 05）. ALB, Hb and PNI of treatment group increased faster than that of control group. ALB and PNI of treatment group 7 d after operation were much higher than that of control group with statistic significance （P〈0. 05）. Index of cellular immunity and humoral immunity all decreased after operation. All patients were recov- ered 7 d after operation as that before operaion except the IgG of control group. IgA and IgG of treatment group reached 2. 7 ± 2. 3 g·L-1 and 14. 5± 4. 1 ·L -1 ,whieh were much higher than that of control group with statistic significance （P〈0.05）. CONCLUSION TPN added with alanyl glutamine can significantly improve the body nutrition and immunity after operation in the patients with esophageal carcinoma.