Yeh Chun-Nan, Lee Hsiang-Lin, Liu Yu-Yin, Chiang Kun-Chun, Hwang Tsann-Long, Jan Yi-Yin, Chen Miin-Fu
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan.
Langenbecks Arch Surg. 2008 Nov;393(6):849-55. doi: 10.1007/s00423-008-0405-4. Epub 2008 Aug 20.
We conducted a prospective and case-controlled study to evaluate the impact of supplement of alanyl-glutamine dipeptide (Gln) in parenteral nutrition on perioperative immune and nutritional changes and clinical outcomes for patients undergoing gastrointestinal (GI) operations.
During 2006, 70 patients undergoing GI surgeries were allocated equally into two groups. One group received regular parenteral nutrition and the other received the same formulation and supplemented with the Gln; the two groups were isonitrogenous. The infusion was started from 1 day before operation to the sixth day after operation for 7 days. Blood samples were collected on the morning of the day before the operation and on the morning 6 days after the operation and analyzed for immune and nutrition parameters.
There were no differences between the two groups in terms of clinical characteristics, operative procedures, biochemistry, nutritional status, and immune status preoperatively. After GI surgery, significant reduction in nutritional and immune parameters were observed in both groups, demonstrated by significant difference of albumin, C-reactive protein (CRP), lymphocyte count, T cell, and CD8 cell. The length of hospital stay is slightly longer in the control group patients, but not to statistical significance (16.3 +/- 21.3 versus 12.2 +/- 6.8 days, p = 0.299). In terms of morbidity, there was no difference between the two groups, but two patients in the control group had wound infection; none was noted in the Gln group (p = 1.0). No surgical mortality was noted in this study.
Perioperative parenteral nutrition supplemented with Gln is beneficial for patients undergoing GI surgery. Gln supplementation significantly attenuated postoperative inflammation and ameliorated postoperative immunodepression as well as nutritional depression in GI surgery.
我们进行了一项前瞻性病例对照研究，以评估肠外营养中添加丙氨酰 - 谷氨酰胺二肽（Gln）对胃肠道（GI）手术患者围手术期免疫、营养变化及临床结局的影响。
2006年期间，70例接受GI手术的患者被平均分为两组。一组接受常规肠外营养，另一组接受相同配方并添加Gln；两组氮量相等。输注从手术前1天开始至手术后第6天，共7天。在手术前一天上午和手术后6天上午采集血样，分析免疫和营养参数。
两组在术前的临床特征、手术操作、生化指标、营养状况和免疫状态方面无差异。GI手术后，两组的营养和免疫参数均显著降低，白蛋白、C反应蛋白（CRP）、淋巴细胞计数、T细胞和CD8细胞有显著差异。对照组患者的住院时间略长，但无统计学意义（16.3±21.3天对12.2±6.8天，p = 0.299）。在发病率方面，两组无差异，但对照组有2例患者发生伤口感染；Gln组未发现（p = 1.0）。本研究未观察到手术死亡病例。
围手术期补充Gln的肠外营养对接受GI手术的患者有益。补充Gln可显著减轻术后炎症，改善GI手术患者术后的免疫抑制和营养抑制。
