添加丙氨酰谷氨酰胺全胃肠外营养对消化道肿瘤术后化疗老年患者的作用

目的研究添加丙氨酰谷氨酰胺（Ala—Gin）的全胃肠外营养（TPN）对消化道肿瘤术后化疗老年患者的作用。方法30例消化道肿瘤老年患者，按序随机分为2组：传统组和二肽组，每组15例，术后给予TPN同时化疗5d。术前术后对人体测量、血浆蛋白、肝肾功能、血脂全套、血淋巴细胞数目等指标进行检测；术后监测每日氮平衡和累积氮平衡。结果二肽组上臂中部肌周长（AMC）、转铁蛋白（TRF）、血淋巴细胞数术后第6天能维持术前水平（P〉0．05），传统组则明显低于术前（P〈0．05）；2组间人体测量、血浆蛋白、肝肾功能、血脂全套、淋巴细胞数差异无显著性（P〉0．05）。术后第6天传统组累积氮平衡为（-32．17±10．16）g，二肽组为（-13．56±5．61）g，2组间差异显著（P〈0．01）。结论老年消化道肿瘤患者术后化疗同时应用添加Ala—Gin的肠外营养是安全有效的，能减轻肿瘤患者术后的分解代谢，有效地改善机体氮平衡，维持血循环中淋巴细胞数目，增强对手术及化疗的耐受性。

Effect of alanyl-glutamine on old patients with gastrointestinal cancer undergoing postoperative chemotherapy

Objective To study the effect of alanyl-glutamine （Ala-Gln） supplemented total parenteral nutrition （TPN） on old gastrointestinal cancer patients undergoing postoperative chemotherapy. Methods Thirty elderly patients receiving postoperative chemotherapy for 5 days were divided into two groups ： conventional TPN group （ control group） and Ala-Gln supplemented group （Ala-Gln group）. All patients received TPN, however,35% of nitrogen was supplied with Ala- Gin in Ala-Gln group. Anthropometric and biochemical parameters were monitored before and after the treatment. Resuits There were no significant differences between the two groups in anthropometric parameters, serum total protein （TP） , albumin （ ALB ） , prealbumin （ PAB ） , transferrin （ TRF ） , total lymphocyte count （ TLC ） , liver function, kidney function and serum lipid parameters. Compared with preoperative data, arm muscle circumference （AMC） , TRF and TLC remained unchanged at the end of the TPN in Ala-Gln group （ P 〉 0. 05 ） , but decreased significantly in control group （ P 〈 0. 05 ）. By the end of the study,cumulated nitrogen balance （CNB） in two groups was -32. 17 ±10. 16 g and - 13.56 ± 5.61g respectively. There were significant differences in nitrogen balance and CNB between the two groups （P 〈 0. 01 ）. Conclusions Ala-Gln supplemented TPN is safe and effective in the elderly patients undergoing postoperative chemotherapy. It attenuates protein catabolism, improving nitrogen balance, maintaining total lymphocyte count.