探讨丙氨酸-谷氨酰胺强化营养支持联合乌司他丁对胃癌切除术后机体免疫及预后的影响

Effect of alanine-glutamine intensive nutritional support combined with ulinastatin on body immunity and prognosis after gastric cancer resection treatment

目的探讨丙氨酸-谷氨酰胺强化营养支持联合乌司他丁对胃癌切除治疗后感染性休克患者机体免疫、血流动力学及预后的影响。方法选取2019年7月至2020年12月在郑州人民医院接受胃癌切除治疗后感染休克的98例患者为对象,按随机数字表法分为实验组和对照组各49例。两组均给予常规方法治疗,对照组丙氨酸-谷氨酰胺强化营养支持干预,实验组联合乌司他丁注射液治疗,两组治疗4周后评估患者效果,比较两组机体免疫、血流动力学、预后及药物安全性。结果治疗前,实验组、对照组辅助性T细胞(CD4^(+))、细胞毒性T细胞(CD8^(+))、辅助性T细胞/细胞毒性T细胞(CD4^(+)/CD8^(+))、免疫球蛋白A(IgA)及免疫球蛋白G(IgG)比较差异无统计学意义(P>0.05);治疗后,实验组各指标水平均高于对照组(P<0.05);治疗前,实验组、对照组全身血管阻力指数(SVRI)、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)等指标比较差异无统计学意义(P>0.05),治疗后,实验组各指标低于对照组(P<0.05);实验组治疗后6个月内死亡率低于对照组(P<0.05)。治疗前,实验组、对照组白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)比较差异无统计学意义(P>0.05);治疗后,两组各指标均有明显下降,实验组降低幅度大于对照组(P<0.05);两组用药期间肝肾异常、腹泻便秘、瘙痒感、皮疹过敏及嗜酸粒细胞增多发生率比较,差异无统计学意义(P>0.05)。结论丙氨酸-谷氨酰胺强化营养支持联合乌司他丁用于胃癌切除治疗后感染性休克患者,有助于增强患者免疫力,改善血流动力学及预后,且药物安全性较高,值得推广应用。

【Objective】To investigate the effects of alanine glutamine fortified nutritional support combined with ulinastatin on the immune system,hemodynamics,and prognosis of patients with septic shock after gastric cancer resection treatment.【Methods】Ninety-eight patients with septic shock after gastric cancer resection treatment at Zhengzhou People's Hospital from July 2019 to December 2020 were selected as the subjects.They were randomly divided into an experimental group and a control group,with 49 patients in each group.Both groups were treated with conventional methods,the control group received alanine glutamine enhanced nutritional support intervention,while the observation group received combined treatment with ulinastatin injection.After 4 weeks of treatment,the patient's efficacy was evaluated,and the immune system,hemodynamics,prognosis,and drug safety between the two groups were compared.【Results】Before treatment,there was no significant difference in the levels of helper T cells(CD4^(+)),cytotoxic T cells(CD8^(+)),helper T cells/cytotoxic T cells(CD4^(+)/CD8^(+)),immunoglobulin A(IgA),and immunoglobulin G(IgG)between the experimental and control groups(P>0.05).After treatment,the levels of various indicators in the experimental group were significantly higher than those in the control group(P<0.05).Before treatment,there was no significant difference in the systemic vascular resistance index(SVRI),extravascular lung water index(EVLWI),and pulmonary vascular permeability index(PVPI)between the experimental group and the control group(P>0.05).After treatment,the experimental group had significantly lower indicators than the control group(P<0.05).The mortality rate within 6 months after treatment in the experimental group was significantly lower than that in the control group(P<0.05).Before treatment,there was no significant difference in IL-6,IL-8,TNF-αbetween the experimental and control group(P>0.05).After treatment,all indicators in both groups showed a significant decrease,with the experimental group showing a significant decrease compared with the control group(P<0.05).There was no statistical difference in the incidence of liver and kidney abnormalities,diarrhea,constipation,itching,rash allergies,and eosinophilia between the two groups during the medication period(P>0.05).【Conclusion】The combination of alanine glutamine fortified nutritional support and ulinastatin in patients with septic shock after gastric cancer resection treatment can help enhance patient immunity,improve hemodynamics and prognosis,and the drug has high safety,which is worth promoting and applying.