L-谷氨酰胺联合肠外营养支持对肺癌患者术后免疫和炎症反应的影响

目的研究肺癌根治术后早期应用L-谷氨酰胺联合肠外营养支持对患者营养状况、免疫和炎性反应的影响。方法选择42例行肺癌根治手术的伴有营养不良的肺部恶性肿瘤患者，随机分为试验组（22例）和对照组（20例）。术后第1-5天，每日给予两组患者静脉营养支持，提供非蛋白热卡90KJ·kg^-1·d^-1，氮0．25g·kg^-1·d^-1。术后第2天起，同时给予两组患者流质饮食，试验组患者每日口服L．谷氨酰胺颗粒30g。分别于术前和术后第1、7天抽取静脉血，检测血清白蛋白、前白蛋白、转铁蛋白、T淋巴细胞分化亚群3（CD3）、CD4、CD8、CD4／CD8、免疫球蛋白A（IgA）、IgG、IgM、C反应蛋白，并进行统计学分析。结果术后第7天试验组的血清转铁蛋白[（2．294±0．34）w．‘（2．15±0．42）g／L]、前白蛋白[（0．27±0．76）vs．（0．23±0．84）g／L]、CD4（30．9％±2．2％128．28．9％±2．3％）、CD4／CD8（1．174-0．19vs．1．104±0．81）、IgG1（12．944±2．08）vs.（11．194±1．95）g／LI的水平均显著高于对照组术后第7天的测定值（P均〈0．05），血清C反应蛋白水平显著低于对照组术后第7天的测定值[（31．6±16．7）vs．（36．54±13．3）mg／L，P〈0．05]。结论肺癌患者术后早期使用L-谷氨酰胺联合肠外营养支持能更好地改善患者的营养状况、免疫功能以及下调机体的急性炎症反应。

Effects of L-glutamine-supplemented parenteral nutritional support on immunity and inflammatory response in post-surgical patients with lung cancer

Objective To investigate the effects of L-glutamine-supplemented parenteral nutritional sup- port on nutritional status, immunity, and inflammatory response in patients with lung cancer following radical opera- tion. Methods Forty-two malnourished patients with lung malignancies who had undergone radical operations were randomly divided into PN plus group (n =22) and PN group (n = 20). From day 1 to day 5 after operations, parenteral nutrients with the non-proteinic calorfic value of 90 kJ · kg-1 d-1 and nitrogen 0.25 g · kg-1 d-1 were given. From day 2, liquid diets were provided to both groups, and L-glutamine particles (30 g) were provided to PN plus group. Peripheral blood specimens were collected before operation, on day 1, and on day 7 after the oper- ations to determine the serum levels of albumin, prealbumin, transferrin, T lymphocyte subgroup 3 (CD3), CD4, CD8, CD4/CD8, immunoglobulin A (IgA), IgG, IgM, and C-reactive protein. Results The levels of the serum transferrin [(2.29±0.34) vs. (2.15±0.42) g/L], prealbumin [ (0. 27±0.76) vs. (0.23±0. 84) g/L], CD4 (30.9%±2.2% vs. 28.9%±2. 3% ), CD4/CD8 (1.17±0.19 vs. 1.10±0. 81), IgG [(12. 94 2.08) vs. (11. 19±1. 95) g/L] were all significantly higher in the PN plus group than those in PN group on day 7 (P <0. 05) . The level of serum C-reactive protein was significantly lower in PN plus group than that in PN group on day 7 [(31.6±16.7) vs. (36.5±13.3) mg/L, P<0.05]. Conclusion Postoperative L-glutamine-supplemented parenteral nutrition support can improve the nutritional status and immune function and reduce the acute inflammatory response in patients with lung cancer.