围手术期补充丙氨酰谷氨酰胺的肠外营养用于慢性放射性肠炎合并手术性肠梗阻患者：一项前瞻性、随机、对照研究

Perioperative Alanyl-Glutamine-Supplemented Parenteral Nutrition in Chronic Radiation Enteritis Patients With Surgical Intestinal Obstruction: A Prospective, Randomized, Controlled Study.

作者信息

Yao Danhua, Zheng Lei, Wang Jian, Guo Mingxiao, Yin Jianyi, Li Yousheng

机构信息

Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P. R. China.

Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P. R. China

出版信息

Nutr Clin Pract. 2016 Apr;31(2):250-6. doi: 10.1177/0884533615591601. Epub 2015 Jun 15.

DOI:10.1177/0884533615591601

PMID:26078286

Abstract

BACKGROUND

A prospective, randomized, controlled study was performed to evaluate the effects of perioperative alanyl-glutamine-supplemented parenteral nutrition (PN) support on the immunologic function, intestinal permeability, and nutrition status of surgical patients with chronic radiation enteritis (CRE)-induced intestinal obstruction.

METHODS

Patients who received 0.4 g/kg/d alanyl-glutamine and isonitrogenous PN were assigned to an alanyl-glutamine-supplemented PN (Gln-PN) group and a control group, respectively. Serum levels of alanine aminotransferase and glutamine, body fat mass (FM), immunologic function, and intestinal permeability were measured before and after surgery.

RESULTS

Serum glutamine levels of the Gln-PN group significantly exceeded that of the control group (P < .001; Gln-PN, baseline 460.7 ± 42.5 vs 523.3 ± 48.6 µmol/L on postoperative day 14 [POD14], P < .001; control, baseline 451.9 ± 44.0 vs 453.8 ± 42.3 µmol/L on POD14, P = .708). Lactulose/mannitol ratios of both groups decreased over time (Gln-PN, baseline 0.129 ± 0.0403 vs 0.024 ± 0.0107 on POD1 4; control, baseline 0.125 ± 0.0378 vs 0.044 ± 0.0126 on POD14, P < .001 in both groups). CD4/CD8-positive T-lymphocyte ratios significantly rose in both groups, with significant intergroup difference (P < .001; Gln-PN, baseline 1.36 ± 0.32 vs 1.82 ± 0.30 on POD14, P < .001; control, baseline 1.37 ± 0.25 vs 1.63 ± 0.31 on POD14, P < .001). In the Gln-PN group, FM increased from 3.68 ± 1.68 kg at baseline to 5.22 ± 1.42 kg on POD14 (P < .001). FM of control group increased from 3.84 ± 1.57 kg at baseline to 5.40 ± 1.54 kg on POD14 (P < .001). However, there were no significant intergroup differences (P = .614).

CONCLUSION

Gln-PN significantly boosted the immune state and decreased the intestinal permeability of CRE patients. However, Gln-PN was not superior to standard PN in improving the nutrition state and intestinal motility of surgical patients with CRE-induced intestinal obstruction.

摘要

背景

进行了一项前瞻性、随机、对照研究，以评估围手术期补充丙氨酰谷氨酰胺的肠外营养（PN）支持对慢性放射性肠炎（CRE）所致肠梗阻手术患者免疫功能、肠道通透性及营养状况的影响。

方法

分别将接受0.4 g/kg/d丙氨酰谷氨酰胺和等氮量PN的患者分配至补充丙氨酰谷氨酰胺的PN（Gln-PN）组和对照组。在手术前后测量血清丙氨酸转氨酶和谷氨酰胺水平、体脂肪量（FM）、免疫功能及肠道通透性。

结果

Gln-PN组血清谷氨酰胺水平显著高于对照组（P <.001；Gln-PN组，基线时460.7±42.5 vs术后第14天（POD14）时523.3±48.6 μmol/L，P <.001；对照组，基线时451.9±44.0 vs POD14时453.8±42.3 μmol/L，P =.708）。两组的乳果糖/甘露醇比值均随时间下降（Gln-PN组，基线时0.129±0.0403 vs POD14时0.024±0.0107；对照组，基线时0.125±0.0378 vs POD14时0.044±0.0126，两组P均<.001）。两组CD4/CD8阳性T淋巴细胞比值均显著升高，且组间差异有统计学意义（P <.001；Gln-PN组，基线时1.36±0.32 vs POD14时1.82±0.30，P <.001；对照组，基线时1.37±0.25 vs POD14时1.63±0.31，P <.001）。在Gln-PN组，FM从基线时的3.68±1.68 kg增加至POD14时的5.22±1.42 kg（P <.001）。对照组FM从基线时的3.84±1.57 kg增加至POD14时的5.40±1.54 kg（P <.001）。然而，组间差异无统计学意义（P =.614）。