谷氨酰胺强化肠内营养对胃癌患者术后炎症反应和肠道屏障功能的影响

Effect of glutamine ennoblement enteral nutrition on postoperative inflammatory reaction and enteric barrier function in patients with gastric cancer

目的观察谷氨酰胺(Gln)强化肠内营养对胃癌患者手术后机体炎症反应和肠黏膜通透性的影响。方法进展期胃癌根治性切除术后患者60例分为Gln强化肠内营养组(Gln组)、常规肠内营养组(EN组)和肠外营养组(PN组),每组20例。术前、术后第1、8天检测患者血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和C-反应蛋白(CRP)水平;术前和术后第9天检测2组甘露醇与乳果糖排除率比值(L/M比值)。结果 3组患者术前IL-6、IL-10和CRP水平比较差别均无统计学意义(P>0.05),术后第1天水平均明显升高,术后第8天水平明显下降,各组术前、术后第1天和术后第8天两两比较差别均有统计学意义(P<0.01)。术后第1天3组IL-6、IL-10和CRP水平比较差别均无统计学意义(P>0.05)。术后第8天,Gln组IL-6水平显著低于EN组和PN组(P<0.01);Gln组和EN组IL-10、CRP水平明显低于PN组(P<0.01)。3组患者术前L/M值比较差别无统计学意义(P>0.05),术后第9天各组均较术前显著升高(P<0.01),且Gln组明显低于PN组(P<0.05)。结论胃癌患者手术后应用Gln强化肠内营养可降低术后高应激反应,增强肠道屏障功能。

Objective To observe the effect of glutamine（Gln） ennoblement enteral nutrition on postoperative inflammatory reaction and enteric barrier function in patients with gastric cancer.Methods Sixty patients with gastric cancer who had undergone radical operations were divided into Gln ennoblement enteral nutrition group（Gln group）,routine enteral nutrition group（EN group） and parenteral nutrition group（PN group）,twenty patients in each group.The levels of serum interleukin-6（IL-6）,interleukin-10（IL-10） and C-reactive protein（CRP） were detected before operation and on the first day,the eighth day after operation.The lactulose and mannitol ratio（L/M） in urine was observed before operation and on the nineth day after the operation.Results There were no statistical differences in the levels of IL-6,IL-10 and CRP in three groups（P0.05）.In three groups,the levels of IL-6,IL-10 and CRP increased on the first day,and decreased on the eighth day.There were statistical differences in the levels of IL-6,IL-10 and CRP among three groups at the different times（P0.01）.On the first day,there were no statistical differences in the levels of IL-6,IL-10 and CRP among the three groups（P0.05）.On the eighth day,the level of IL-6 was significantly lower in Gln group than that in EN and PN groups（P0.05）,the levels of IL-10 and CRP were significantly higher in Gln and EN groups than those in PN group（P0.01）.Before operation,there was no statistical difference in the value of L/M among three groups（P0.05）.On the nineth day,the values of L/M in three groups were obviously higher after operation than those before operation（P0.01）,and the value of L/M in Gln group was lower than that in PN group（P0.05）.Conclusion Postoperative Gln ennoblement enteral nutrition can reduce the acute inflammatory response and strengthen enteric barrier function in patients with gastric cancer.