肠外高营养对重症溃疡性结肠炎患者血清胃动素,肽YY,IgG和糖蛋白含量的影响

Effects of parenteral hyperalimentation on serum motilin, peptide YY, IgG and glycoproteins in severe ulcerative colitis

目的:肠外高营养对重症溃疡性结肠炎患者血清胃动素,肽YY,IgG和糖蛋白含量的影响并讨论其变化的临床意义.方法:重症溃疡性结肠炎患者89例,男51例,女38例,年龄23-57(平均38±13)岁,均经电子结肠镜检查和X线钡灌肠检查,以及组织学检查确诊,并连续粪培养2次排除细菌感染,同时排除阿米巴肠病,血吸虫病,肠道肿瘤和内分泌疾病.病变部位包括乙状结肠45例,降结肠21例,结肠脾曲15例和横结肠8例;临床类型包括复发型44例,持续型30例和初发型15例.采取肠外静脉补充足够的营养,完全胃肠道休息.并于确诊后3d内和治疗缓解后的上午07∶00空腹采血,用放射免疫法(RIA)测定血清胃动素(MTL),肽YY(PYY)和IgG,用血清电泳法测定α1,α2和γ糖蛋白.结果:经过4wk治疗后痊愈27例(30%),好转48例(54%),无效14例(16%),总有效率84%.与对照比较,重症溃疡性结肠炎患者血清MTL(ng/L,311.6±99.8vs207.3±98.4,P<0.01),PYY(pmol/L,1.6±0.8vs1.1±0.6,P<0.05),IgG(g/L,23.6±10.2vs13.1±6.9,P<0.01)和α1球蛋白(g/L,2.7±1.2vs1.5±0.9,P<0.01)明显升高,而α2球蛋白(g/L,4.2±2.6vs6.8±2.3,P<0.05)则降低,但经过治疗后可恢复,治疗有效和无效患者间上述变化无明显差异(P>0.05).全部患者血清AST,ALT在正常范围,血清白蛋白治疗后明显好转(g/L,34.2±9.6vs21.4±8.7,P<0.05),组织学也明显改善.结论:重症溃疡性结肠炎肠外静脉高营养疗法是一种有效可行的方法,且可以改善血清MTL,PYY,IgG和α1,α2糖蛋白水平.

AIM:To study the effects and clinical significance of parenteral hyperalimentation on levels of serum motilin, peptide YY, IgG and glycoproteins in patients with severe ulcerative colitis. METHODS:Eighty-nine patients (males 51,females 38,age 23-57 years) with severe ulcerative colitis were examinated with colonoscope, barium enema, the diagnosis was confirmed histologically. Bacterial infection was excluded through twice consecutive stool cultures. And ameba, schistosomiasis, gastroentertinal cancer and endocrine diseases were also excluded. Ulcerative colitis was found in sigmoid (n =45), descending colon (n =21), colon splenic flexure (n =15) and transverse colon (n =8). Its clinical categories included relapse (n =44), persistent (n =30) and initial (n =15). Parenteral hyperalimentation was applied to patients once diagnosis was made; three days later, fasting venous blood was drawed to test serum motilin (MTL), peptide YY (PYY) and IgG by radioimmunoassy, and serum α1, α2 and γ glycoproteins by electrophoresis. RESULTS:After 4-week period therapy with parental hypernutrition,27 cases (30 %) recovered completely, 48 (54 %) improved, and 14(16 %) failed to therapy, the totaleffective rate was 84 %. Level of serum MTL, PYY, IgG, and α1-glycoprotein in colitis patients were significant higher than those in control, α 2-glycoprotein was lower than that in control ( P <0.05). All these abnormal data became normal after treatment.However,no difference of these parameters was observed between patients who were effective to therapy and those who failed to therapy (P <0.05).No obvious change in serum aspartate aminotransferase (AST), alanine ami- notransferase (ALT) and γ- glycoprotein was existed in all patients (P >0.05).Level of serum albumin was increased (P <0.05),and the histological change in ulcerative colitis was significantly improved after treatment. CONCLUSION:The parenteral hyperalimentation therapy improved effectively serum levels of motilin, PYY, IgG and glycoproteins in patients with severe ulcerative colitis.