谷氨酰胺补充剂与放化疗对晚期食管癌患者全身免疫及肠道屏障功能的影响
Effects of glutamine supplements and radiochemotherapy on systemic immune and gut barrier function in patients with advanced esophageal cancer.
作者信息
Yoshida S, Matsui M, Shirouzu Y, Fujita H, Yamana H, Shirouzu K
机构信息
First Department of Surgery, Kurume University, School of Medicine, Japan.
出版信息
Ann Surg. 1998 Apr;227(4):485-91. doi: 10.1097/00000658-199804000-00006.
OBJECTIVE
The objective of this study was to determine whether oral glutamine supplements can protect lymphocyte and gut barrier function in patients with advanced esophageal cancer undergoing radiochemotherapy.
SUMMARY BACKGROUND DATA
Glutamine supplements improved protein metabolism in tumor bearing rats who underwent chemotherapy and reduced the toxicity of chemotherapy through an enhancement of glutathione production in rats.
METHODS
Thirteen patients with esophageal cancer were randomly placed in either a control or a glutamine group. Glutamine was administered orally (30 g/day) at the start of radiochemotherapy and for the subsequent 28 days. All patients underwent mediastinal irradiation and chemotherapy consisting of 5-fluorouracil and cisplatin. The lymphocyte count was determined, and blast formation was assessed after stimulation with phytohemagglutinin and concanavalin A. Gut barrier function was assessed by measuring the total amount of phenolsulfonphthalein excreted in the urine after the oral administration of phenolsulfonphthalein.
RESULTS
Glutamine supplements prevented a reduction in the lymphocyte count (control: 567 +/- 96/mm3 vs. glutamine: 1007 +/- 151, p < 0.05), and blast formation of lymphocyte (phytohemagglutinin, control: 19478 +/- 2121 dpm vs. glutamine: 33860 +/- 1433, p < 0.01, concanavalin A, control: 19177 +/- 1897 dpm vs. glutamine: 29473 +/- 2302, p < 0.01), and amount of phenolsulfonphthalein excretion in the urine was greater with control than with glutamine group (control: 15.4 +/- 2.4% vs. glutamine: 7.4 +/- 1.2, p < 0.05) 7 days after the initiation of radiochemotherapy.
CONCLUSIONS
Oral glutamine supplementation protects lymphocytes and attenuates gut permeability in patients with esophageal cancer during radiochemotherapy.
目的
本研究旨在确定口服谷氨酰胺补充剂能否保护接受放化疗的晚期食管癌患者的淋巴细胞和肠道屏障功能。
总结背景数据
谷氨酰胺补充剂改善了接受化疗的荷瘤大鼠的蛋白质代谢，并通过增强大鼠体内谷胱甘肽的产生降低了化疗的毒性。
方法
13例食管癌患者被随机分为对照组或谷氨酰胺组。在放化疗开始时及随后的28天内口服谷氨酰胺（30克/天）。所有患者均接受纵隔照射及由5-氟尿嘧啶和顺铂组成的化疗。测定淋巴细胞计数，并在用植物血凝素和刀豆球蛋白A刺激后评估细胞增殖。通过测量口服酚磺酞后尿中排出的酚磺酞总量来评估肠道屏障功能。
结果
谷氨酰胺补充剂可防止淋巴细胞计数减少（对照组：567±96/mm³，谷氨酰胺组：1007±151，p<0.05），以及淋巴细胞的细胞增殖（植物血凝素，对照组：19478±2121 dpm，谷氨酰胺组：33860±1433，p<0.01；刀豆球蛋白A，对照组：19177±1897 dpm，谷氨酰胺组：29473±2302，p<0.01），并且在放化疗开始7天后，对照组尿中酚磺酞排泄量大于谷氨酰胺组（对照组：15.4±2.4%，谷氨酰胺组：7.4±1.2，p<0.05）。
结论
口服补充谷氨酰胺可保护食管癌患者在放化疗期间的淋巴细胞，并减轻肠道通透性。
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