添加谷氨酰胺和精氨酸的强化肠外营养液在肝移植病人术后的应用

Application of enhanced parenteral nutrition with glutamine and arginine after liver transplantation

目的:探讨添加谷氨酰胺和精氨酸的强化肠外营养液对肝移植病人术后肝功能恢复、蛋白质合成、细胞因子含量、急性排异反应和感染发生等的影响。方法:将46例肝移植病人随机分为对照组和强化营养组。强化营养组病人每天在肠外营养液中添加丙氨酰谷氨酰胺20 g和精氨酸20 g。检测病人术后第1、3、5、7天血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、清蛋白(ALB)和前清蛋白(PA)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)含量以及急性排异反应和感染的发生率等指标。结果:强化营养组病人术后第5天ALT、AST和TNF-α明显低于对照组(P<0.05),而IL-10明显高于对照组(P<0.05);术后第7天ALB和PA高于对照组(P<0.05)。两组病人急性排异反应的发生率无显著性差异。强化营养组病人术后感染的发生率明显低于对照组(P<0.05)。结论:添加谷氨酰胺和精氨酸的强化肠外营养可增加肝移植病人术后蛋白质合成,促进肝功能恢复,减轻移植肝缺血-再灌注损伤,降低感染发生率,且不增加急性排异反应的发生。

Objective： To explore the effects of glutamine and arginine enhanced parenteral nutrition on liver function, protein synthesis, cytokine levels, acute rejection and infection after liver transplantation. Methods： Forty-six patients with liver transplantation were randomly divided into the control and the nutrition group enriched with glutamine （20 g/d） and arginine （20 g/d）. The serum levels of alanineaminotransferase （ ALT）, aspartate aminotransferase （ AST）, serum albumin （ALB） and prealbumin （PA）, tumor necrosis factor-a （TNF-cx） and interleukin -10 （IL-10） were measured on 1, 3,5,7 day after liver transplantation respectively. Acute rejection and infection rates were monitored. Results ： ALT and AST levels of the enhanced parenteral nutrition group were significantly lower than the control group on 5 th day （ P 〈 0.05 ）. Serum levels of ALB and PA were significantly increased on 7 th day. The enhanced parenteral nutrition group had lower TNF-oL levels and higher IL-10 levels as compared with the control group on 5 th day. The incidence of acute rejection was not significant difference between the two groups. The incidence rate of infection in the enhanced parenteral nutrition group was significantly lower than the control group （P 〈 0. 05）. Conclusion ： Enhanced parenteral nutrition with glutamine and arginine after liver transplantation can increase protein synthesis ,promote liver function,reduce liver ischemia- reperfusion injury and decrease infection rates,but does not increase the incidence of acute rejection. F I7 .,a_ q