谷氨酰胺双肽对全胃切除患者结局的影响

目的观察丙胺酰．谷氨酰胺双肽（Ala—Gln）对全胃切除患者结局的影响。方法选取符合研究方案、需要接受6天肠外营养的择期全胃切除患者40例，随机分为研究组和对照组，每组20例。两组均行全胃切除，并经外周静脉穿刺中心静脉置管途径给予等氮、等热量的肠外营养支持，其中研究组添加Ala—Gln0．5g·kg^-1·d^-1，对照组接受的营养液只含有平衡氨基酸。两组分别于术前1天，术后3小时，1、4和7天采血2．5ml，测定终点指标及替代有效性指标。结果与对照组相比，研究组感染相关并发症（P〈0．05）和住院时间（P〈0．01）显著降低，CD4和CD4／CD8比值显著升高（P〈0．01），肿瘤坏死因子α、可溶性白细胞介素-2受体和C反应蛋白显著降低（P〈0．01）。结论Ala-Gln可明显增强全胃切除患者的免疫力，对临床近期预后有较好的影响。

Effect of Alanyl-glutamine on the Clinical Outcome of Patients after Total Gastrectomy

Objective To investigate the effect of alanyl-glutamine （Ala-Gln） on clinical outcome of patients after total gastrectomy. Methods Totally 40 patients undergoing selective operation, eligible for the requirement of protocol, and needing 6 days total parenteral nutrition （TPN） support were randomly divided into the study group （ n = 20） and control group （ n = 20 ）. All the patients undergone total gastrectomy and their gastrointestinal tracts were rebuilt. The parenteral alimentation was fulfilled by peripherally inserted central catheter （PICC）. All patients were given equal calorie and equal nitrogen except that patients in the study group were added with Ala-Gln （ Ala-Gln, 0.5 g · kg^-1·d^-1 ）. Pleamin-P was the only element in the parenteral nutrition for the control group. For each patient, 2.5 ml blood samples were taken at 5 time points ： 1 day before operation and 3 hours, 1 day, 4 days, and 7 days after operation. The end-points and surrogate end-points were measured. Results Compared with the control group, the infectious complications and hospitalization duration of the study group significantly decreased, the levels of CD4 and CD4/CD8 signifcantly increased （ P 〈 0.01 ） , while the levels of tumor necrosis factor α, soluble interleukin-2 receptor, C-reactive protein significantly decreased （ P 〈 0.01 ）. Conclusion Parenteral Ala-Gln nutrition can enhance the immunity of patients after total gastrectomy, and improve their early clinical outcomes.