丙氨酰谷氨酰胺辅助肠内外营养对极低出生体质量儿胃肠激素、炎症细胞因子水平及生长发育的影响

Effects of alanyl-glutamine-enriched enteral nutrition and parenteral nutrition on gastrointestinal hormones,levels of inflammatory cytokines,growth and development of very low birth weight infants

目的探讨丙氨酰谷氨酰胺辅助肠内外营养对极低出生体质量儿胃肠激素、炎症细胞因子水平及生长发育的影响,为临床采取干预措施提供参考依据。方法选取2017年1月-2018年6月在嘉兴市妇幼保健院分娩并转入新生儿科的极低出生体质量儿120例,根据营养方案不同分为观察组和对照组,每组60例。对照组进行常规肠内外营养,观察组在对照组基础上给予丙氨酰谷氨酰胺辅助干预。分别于营养前和营养28 d后测定血浆胃动素、血清胃泌素以及血清转化生长因子-β(TGF-β)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10 (IL-10)水平;称量患儿体质量,计算体质量日均增长水平;记录达到全肠道喂养的时间和恢复出生体质量时间。结果营养28 d后两组极低出生体质量儿血浆胃动素、血清胃泌素水平明显高于营养前,差异有统计学意义(均P<0. 01);且观察组血浆胃动素、血清胃泌素水平明显高于对照组,差异有统计学意义(均P<0. 01)。营养28 d后两组极低出生体质量儿血清TGF-β、IL-10水平明显高于营养前,TNF-α水平明显低于营养前,差异有统计学意义(均P<0. 05);且观察组血清TGF-β、IL-10水平明显高于对照组,TNF-α水平明显低于对照组,差异有统计学意义(均P<0. 05)。营养28 d后,观察组极低出生体质量儿喂养不耐受发生率明显低于对照组,达到全肠道喂养的时间、恢复出生体质量时间明显短于对照组,体质量日均增长幅度明显大于对照组,差异有统计学意义(均P<0. 05)。结论丙氨酰谷氨酰胺辅助肠内外营养可有效调节极低出生体质量儿的胃肠激素水平和炎症细胞因子水平,改善喂养不耐受,缩短达到全肠道喂养的时间,改善生长发育水平。

Objective To explore the effects of alanyl-glutamine-enriched enteral nutrition and parenteral nutrition on gastrointestinal hormones,levels of inflammatory cytokines,growth and development of very low birth weight infants,provide a reference basis for taking clinical interventional measures. Methods A total of 120 very low birth weight infants born in Jiaxing Municipal Maternal and Child Health Care Hospital and trnaferred into Department of Neonatology from January 2017 to June 2018 were selected and divided into observation group and control group according to different nutritional schemes,60 infants in each group. The infants in control group were given routine enteral nutrition and parenteral nutrition. The infants in observation group were given alanyl-glutamine-enriched enteral nutrition and parenteral nutrition. The levels of plasma motilin,serum gastrin,TGF-β,TNF-α,IL-10 before nutrition and at 28 days after nutrition were detected,the weights of the children were weighed,the average daily weight gain was calculated. The time of reaching intestinal feeding and the time of recovering birth weight were recorded. Results At 28 days after nutrition,the levels of plasma motilin and serum gastrin were statistically significantly higher than those before nutrition( P<0. 01). The levels of plasma motilin and serum gastrin in observation group were statistically significantly higher than those in control group( P<0. 01). At 28 days after nutrition,the levels of serum TGF-β and IL-10 in the two groups were statistically significantly higher than those before nutrition,while the levels of TNF-α in the two groups were statistically significantly lower than those before nutrition( P<0. 05). The levels of serum TGF-β and IL-10 in observation group were statistically significantly higher than those in control group,while the level of serum TNF-α in observation group was statistically significantly lower than that in control group( P<0. 05). At 28 days after nutrition,the incidence rate of feeding intolerance in observation group was statistically significantly lower than that in control group,the time of reaching intestinal feeding and the time of recovering birth weight in observation group were statistically significantly shorter than those in control group,the average daily weight gain in observation group was statistically significantly larger than that in control group( P<0. 05). Conclusion Alanyl-glutamine-enriched enteral nutrition and parenteral nutrition can effectively regulate the levels of gastrointestinal hormones and inflammatory cytokines of very low birth weight infants,improve feeding intolerance,shorten the time of reaching total intestinal feeding,and improve growth and development level.