丙氨酰谷氨酰胺对消化道肿瘤术后化疗患者蛋白质代谢的影响

Effect of Alanyl-Glutamine on Protein Metabolism in Gastro intestinal Cancer Patients Undergone Postoperative Chemotherapy

目的 :研究丙氨酰谷氨酰胺 (Ala- Gln)添加全胃肠外营养 (TPN)对消化道肿瘤术后化疗患者蛋白质代谢的影响。方法 :30例消化道癌肿患者随机分为两组 :传统组和二肽组 ,术后给予等热量 (每千克体重 10 4k J)、等氮量 (每千克体重 0 .16 g)、TPN同时化疗 5天。手术前后对人体测量、血浆蛋白、淋巴细胞计数等指标进行监测 ;术后留 2 4h尿测氮平衡和累积氮平衡。结果 :二肽组转铁蛋白 (TF)、淋巴细胞数术后第 6天能维持术前水平 (P>0 .0 5 ) ,传统组则明显低于术前 (P<0 .0 5 ) ;两组间人体测量、血浆蛋白、淋巴细胞数差异无显著性。术后第 6天传统组累积氮平衡为 (- 32 .17± 10 .16 ) g,二肽组为 (- 13.5 6± 5 .6 1) g,两组间每日氮平衡和累积氮平衡差异显著 (P<0 .0 1)。结论 :Ala- Gln在肠外营养中的使用是安全有效的 ,能减轻肿瘤患者术后的分解代谢 ,有效地改善氮平衡 ,维持血循环中淋巴细胞的数目 。

Objective:To study the effect of alanyl-glutamine (A la-Gln) supplemented total parenteral nutrition (TPN) on protein metabolism in patients undergoing postoperative chemotherapy. Methods:Thirty patie nts with gastrointestinal cancer were divided into two groups: conventional TPN( Control group) and Ala-Gln supplemented group (Ala-Gln group). All patients re ceived isocaloric (104.6 kJ·kg -1 ·d -1 ) and isonitrogenous (0.16 g· kg -1 ·d -1 , 35% of nitrogen was suppled with Ala-Gln in Ala-Gln gro up) TPN as well as postoperative chemotherapy for 5 days. Anthropometric and bio chemical parameters were monitored before and after the treatment. Results :There were no significant differences between the two groups in anthropomet ric parameters,serum total protein (TP), albumin (ALB), prealbumin (PAB), transf errin (TF), total lymphocyte count(TLC). Compared with that on preoperative day, TF, TLC maintained unchangeableness on the end of the TPN in Ala-Gln group ( P>0.05), but significantly decreased in control group (P<0.05). By the end of the study cumulated nitrogen balance(CNB) in the two groups was ( 32.17±10.16) g/5d and (13.56±5.61) g/5d respectively. There were signi ficant differences in nitrogen balance and CNB between the two groups (P<0.01 ). Conclusion:Ala-Gln supplemented TPN was safe and effective. It a ttenuated protein catabolism, improved nitrogen balance, maintained total lympho cyte count in the patients with postoperative chemotherapy.