丙氨酰-谷氨酰胺双肽对外科危重患者术后免疫功能的临床研究

Effect of Alanl-glutamine on Postoperative Immunofunction of Critically Surgical Patients

目的研究丙氨酰-谷氨酰胺(Ala-Gln)对外科危重患者术后免疫功能的影响.方法将54例外科急症大手术后APACHEⅡ评分大于12分的患者随机分成实验组和对照组,两组均予等氮等热量104.5～125.4kJ/(kg·d)营养支持;对照组给予一般的肠外营养(PN)支持,治疗组给予谷氨酰胺为底物的肠外免疫营养支持.两组患者均于术前、术后营养支持7d后检测清蛋白(ALB)、前清蛋白(PAB)和转铁蛋白(TRF)以及IgG,IgA和IgM和T淋巴细胞亚群CD3,CD4,CD8.结果治疗组免疫营养支持7d后ALB,PAB和TRF均明显上升(P<0.05),而对照组ALB,PAB和TRF与支持前比较差异无统计学意义(P>0.05),治疗组PAB的增加值明显高于对照组(P<0.05);IgA、IgG和IgM均高于营养支持前和对照组(P<0.05),T淋巴细胞亚群CD4百分比和CD4/CD8值均高于营养支持前和对照组(P<0.05).结论丙氨酰-谷氨酰胺强化的肠外营养能提高外科危重患者术后免疫球蛋白和淋巴细胞计数,提高免疫功能.

Objective To investigate the effect of alanyl-glutamine （Ala-Gln） on the postoperative immune function of critically surgical patients.Methods Fifty-four critically surgical patients with APACHE Ⅱ score12 were randomly divided into treatment group and control group.All patients in the two groups were treated with with routine surgical treatment combined with parenteral nutrition and observed for 7 days.Patients in the control group were given general parenteral nutrition （PN） and patients in the treatment group were treated with L-glutamine as substrate parenteral nutrition support immunization.The albumin （ALB）,prealbumin （PAB）,and transferrin （TRF）,as well as IgG,IgA,and IgMand the T-lymphocyte subsets CD3,CD4,and CD8 of patients in the two groups were detected before operation and 7 days after postoperative nutritional support.Results The ALB,PAB,and TRF of patients in the treatment group were significantly increased 7 days after nutritional support with alanyl-glutamine （P 0.05）,while the ALB,PAB and TRF of patients in the control group had no no significant difference before and after nutritional support （P0.05）.The increase of PAB in the treatment group was significantly higher than that in the control group （P0.05）.The IgA,IgG and IgM of patients in the treatment group after nutritional support were higher than the control group and before nutritional support （P0.05）.The T-lymphocyte subsets CD4 percentage and CD4/CD8 values of patients in the treatment group after nutritional support were higher than before nutritional support and the control group （P0.05）. Conclusion The strenghthed parenteral nutrient of Ala-Gln can increase the postoperative immunoglobulin and number of lymphocytes of critically surgical patients,thus improve the immunofunction of the surgical patients.