丙氨酰谷氨酰胺对胃肠道肿瘤患者术后营养及免疫功能的影响

Effect of alanyl-glutamine dipeptides on the nutrition and immunofunction in postoperative patients of gastrointestinal neoplasms

目的评价丙氨酰谷氨酰胺注射液（Ala—Gin）强化的胃肠外营养（TPN）对胃肠道肿瘤患者术后营养和免疫状况的影响。方法137例胃肠道肿瘤患者术后被随机分为研究组66例和对照组71例，所有患者术后第1～7天给予TPN，等热量（104．5kJ·kg^-1·d^-1）、等氮（0．2g·kg^-1·d^-1），研究组另加入Ala—Gin注射液0．4g·kg^-1·d^-1。分别于术前1d及术后第4、8天观察血浆白蛋白（Alb）、前白蛋白（PAB）、转铁蛋白（TF），计算氮平衡变化，同时检测外周血．IgA、IgG、IgM。结果术后两组患者Alb、PAB、TF较术前均有不同程度下降，研究组恢复优于对照组，在术后第8天两组比较差异有统计学意义（P〈0．05）。纠正负氮平衡研究组明显优于对照组，差异统计学意义（P〈0．05）。研究组术后第8天IgA、IgG、IgM恢复较对照组差异具有统计学意义（P〈0．05）。结论加入Ala—Gin双肽加TPN可以改善胃肠道肿瘤患者术后营养，提高患者的免疫功能。

Objective To evaluate the impact of total parenteral nutrition supplemented alanyl-glutamine on the postoperative nutrition and immunofunction of patients with gastrointestinal neoplasms. Methods One hundred and seventeen patients were randomly divided into study group（n=66） and control group（n=71）. The patients in two groups receive isoenergetic （104.5 kJ·kg^-1·d^-1） and isonitrogenous （0.2 g·kg^-1·d^-1） TPN from postoperative first day to the seventh. Whereas the study group received additional 0.4g·kg^-1·d^-1 of Ala-Gln. Blood samples were collected on the morning of the first day before the operation and on the morning day 4 and day g after the operation and analyzed for immune and nutrition parameters. Nitrogen balance was calculated simultaneously. Results Serum albumin, pre-albumin transferrin levels were both decreased in the two groups after surgery. The outcome of study group was better than that of the control group in day 8 after operation （P 〈0.05）. Nitrogen balance in the Study group was better than the control group also （P 〈0.05）. Compared with control group, the level of IgA, IgG, IgM in the Study group had increased in day 8 significantly （P 〈0.05）. Conclusion Ala-Gln dipeptide in TPN is beneficial to postoperative patients of gastrointestinal neoplasms, and can improve patient＇s nutrition, enhance their immune function.