谷氨酰胺在局部晚期鼻咽癌诱导化疗中对肠道屏障功能的影响

The effects of glutamine on intestinal barrier function in patients with locally advanced nasopharyngeal carcinoma during neoadjuvant chemotherapy: a clinical study

目的探讨谷氨酰胺对局部晚期鼻咽癌患者诱导化疗后肠道屏障功能的影响。方法非随机纳入80例局部晚期(Ⅲ～Ⅳb期)鼻咽癌患者,分为试验组(n=42)和对照组(n=38),两组均给予两周期多西他赛+顺铂+5-氟尿嘧啶(TPF)诱导化疗,试验组在诱导化疗时加用丙氨酰谷氨酰胺注射液,分别测定两组诱导化疗前后白蛋白、前白蛋白、血红蛋白、二胺氧化酶(DAO)及淋巴免疫功能、体质指数,评价两组诱导化疗恶心、呕吐、腹泻毒性不良反应及诱导化疗后近期疗效评价。结果 (1)试验组诱导化疗后DAO水平较对照组低,差异有统计学意义(P=0.003),试验组诱导化疗后CD3^+较对照组高,差异有统计学意义(P=0.00),余指标差异无统计学意义(P>0.05);(2)对照组亚组分析诱导化疗后DAO水平较诱导化疗前高,差异有统计学意义(P=0.002),诱导化疗后前白蛋白水平较诱导化疗前减低,差异有统计学意义(P=0.00),诱导化疗后CD3^+、CD3^+CD8^+、CD45^+、CD4^+/CD8^+降低,差异有统计学意义(P<0.05);(3)试验组亚组分析在前白蛋白水平上诱导化疗后有增加,差异有统计学意义(P=0.001),在血红蛋白、白蛋白、CD4^+/CD8^+水平上,诱导化疗后较诱导化疗前减低,差异有统计学意义(P<0.05)。结论 (1)TPF诱导化疗方案对肠道屏障功能,营养、免疫功能部分指标有损伤作用;(2)谷氨酰胺对局部晚期鼻咽癌患者行TPF方案诱导化疗后肠道屏障功能、营养、免疫功能部分指标有一定改善作用。

Objective To explore the effects of glutamine on intestinal barrier function in patients with local advanced nasopharyngeal carcinoma（ NPC） after neoadjuvant chemotherapy. Methods Eighty patients with local advanced NPC were divided into experimental group（ n = 42） and control group（ n = 38）. And both of the two groups adopted the chemotherapy scheme of docetaxel ＋ cisplatin ＋ fluorouracil（ TPF）. Only experimental group received the injection of propylene ammonia acyl-glutamine. Before and after the chemotherapy,albumin（ Alb）,hemoglobin（ Hb）,diamine oxidase（ DAO）,prealbumin（ PA）,lymphocyte immune function and body mass index（ BMI） were tested before and after the neoadjuvant chemotherapy. The adverse events,including nausea,vomiting,diarrhea and short-term curative effect were recorded. Results The value of DAO was significantly lower in experimental group than control group（ P = 0. 003）,and the value of CD3＋ was significantly higher in experimental group than control group after the chemotherapy（ P = 0. 00）,while there was no significant difference in other indicators between the 2 groups（ P 〉 0. 05）. The analysis of the control group showed that the value of DAO after neoadjuvant chemotherapy was significantly higher than that before chemotherapy（ P = 0. 002）,and the values of CD3＋,CD3＋CD8＋,CD45＋,CD4＋/CD8＋ and PA after neoadjuvant chemotherapy were significantly lower than those before it（ P〈 0. 05）. The value of PA was significantly higher after the chemotherapy than before chemotherapy（ P = 0. 001）,while the values of Hb and Alb were significantly lower after the chemotherapy than before it in experimental group（ P〈 0. 05）. Conclusion The treatment scheme of TPF has negative effects on intestinal barrier function,some of the indicators of nutrition and immune function. Glutamine may play a certain role to improve intestinal barrier function,and some of indicators of the immune function and nutrition in patients with local advanced NPC accepted induction chemotherapy.