谷氨酰胺辅助肠内、外营养对极低出生体质量儿胃肠激素水平的影响

目的 探讨谷氨酰胺(Gln)辅助肠内、外营养对极低出生体质量儿(VLBWI)相关细胞因子及胃肠激素水平的影响.方法 选取2014年11月至2016年11月河北北方学院附属第一医院新生儿科出生的VLBWI共60例,依据营养方案不同,分为试验组和对照组,每组各30例.对照组接受常规肠内、外营养干预,试验组在对照组基础上,给予Gln辅助干预.分别测定两组患儿干预前后血浆胃动素(MOT)、血清胃泌素(GAS)及血清白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β),记录喂养不耐受发生情况、恢复至出生体质量所需时间及达到全胃肠道喂养时间,测量体质量,并计算28 d平均日增长情况.结果 试验组干预后MOT、GAS、IL-10、TGF-β水平高于对照组,TNF-α水平低于对照组(P<0.05,P<0.001);试验组喂养不耐受发生率低于对照组(P<0.05),达全肠道喂养时间、恢复至出生体质量时间均短于对照组(P<0.001),平均日体质量增长高于对照组(P<0.001).结论 Gln辅助肠内、外营养可有效调节VLBWI胃肠激素水平,改善喂养不耐受,缩短达全肠道喂养时间.

The Effect of the Enteral and Parenteral Nutrition Assisted with Glutamine on the Gastrointestinal Hormones of VLBWI

Objective To explore the effect of the enteral and parenteral nutrition assisted with glutamine on the relevant cytokines and gastrointestinal hormones of very low birth weight infants (VLBWI).Methods A total of 60 VLBWI who were born in The First Affiliated Hospital of Hebei North University from November of 2014 to November of 2016 were included in the study and randomized into the experiment group and the control group.The patients in the control group were given the routine interventions of enteral and parenteral nutrition, while the patients in the experiment group were given the routine interventions combined with the Gln-assisting interventions.The plasma motilin (MOT), serum gastrin (GAS), serum interleukin-10 (IL-10), tumor necrosis factor alpha (TNF-α), and transforming growth factor beta (TGF-β) of the two groups were detected before and after intervention respectively.The feeding intolerance, the required time for the recovery to the birth weight and the time for reaching the whole gastrointestinal feeding were recorded.The body weight was measured, and the 28d average daily growth was calculated.Results The levels of MOT, GAS, IL-10, and TGF-β in the experiment group were significantly higher than those in the control group after interventions (P<0.05, P<0.01), while TNF-α level was significantly lower than that in the control group (P<0.05).The occurrence rate of feeding intolerance was significantly lower in the experiment group than in the control group, the required time for the recovery to the birth weight and the time for reaching the whole gastrointestinal feeding in the experiment group were significantly shorter than those in the control group, and the average weight gain was significantly more in the experiment group than in the control group (P<0.01).Conclusion The enteral and parenteral nutrition assisted with glutamine can effectively regulate the gastrointestinal hormones of VLBWI, reduce the feeding intolerance and shorten the time for reaching the whole gastrointestinal feeding.