摘要
目的探讨丙氨酰谷氨酰胺(Ala-Gln)治疗对胰腺癌切除术后患者免疫功能和肠道通透性的影响。方法回顾性分析2018年6月至2020年12月收治的110例胰腺癌患者的临床资料,按照患者术后采取的治疗方式不同分为观察组和对照组,每组55例,两组患者术后均接受营养和对症支持治疗,观察组患者术后1 d开始给予Ala-Gln注射液治疗,对照组患者给予同等剂量的生理盐水作为安慰剂治疗。观察比较两组患者术后5 d外周血谷氨酰胺双肽(Gln)、总淋巴细胞计数(TLC),血清免疫球蛋白(Ig)A、IgG、IgM水平,尿乳果糖/甘露醇(L/M)比值和血浆二胺氧化酶(DAO)水平;对比两组患者术后7 d的血糖控制情况、治疗期间不良反应和院内病死率。结果术后1 d两组患者外周血Gln、TLC,血清IgA、IgG、IgM水平比较,差异均无统计学意义(P>0.05);与术后1 d比较,术后5 d观察组患者外周血Gln及血清IgA、IgG、IgM水平均明显升高(P<0.05),且观察组患者外周血Gln、TLC及血清IgA、IgG、IgM水平均明显高于对照组(P<0.05)。术后1 d两组患者尿L/M比值和血浆DAO水平比较,差异均无统计学意义(P>0.05);与术后1 d比较,术后5 d观察组患者尿L/M比值差异无统计学意义(P>0.05),而血浆DAO水平明显降低(P<0.05);对照组患者尿L/M比值、血浆DAO水平明显升高且高于观察组患者(P<0.05)。术后两组患者血糖达标时间、胰岛素使用量相比较差异均无统计学意义(P>0.05);两组患者主要不良反应均为脂肪泻、腹胀、腹痛、肠外营养支持相关肝病等,两组均未见患者因并发症导致的休克、死亡等事件发生,且观察组患者治疗期间不良反应率明显低于对照组(23.64%vs.41.82%,χ^(2)=12.017,P<0.001)。两组患者院内疾病全因素病死率比较,差异无统计学意义(5.45%vs.7.25%,χ^(2)=1.032,P=0.695)。结论Ala-Gln注射液治疗能维持胰腺癌切除术后患者血浆Gln水平,并改善免疫指标,维持肠道通透性且安全性良好,利于患者术后的恢复。
Objective To explore the effect of alanyl glutamine(Ala-Gln)treatment on the postoperative immune function and intestinal permeability of the patients with pancreatic cancer resection.Methods The clinical data of 110 patients with pancreatic cancer admitted to this hospital from June 2018 to December 2020 were retrospectively selected as the research subjects.According to the postoperative treatment methods,the patients were divided into the observation group and control group,55 cases in each group.The two groups all received the nutritional and symptomatic supportive treatment after operation.The observation group was given the Ala-Gln injection on postoperative 1d,and the control group was given the same amount of normal saline as the placebo.The peripheral blood glutamine dipeptide(Gln)level,TLC counts,serum IgA,IgG,IgM levels,urine L/M ratio and blood DAO levels on postoperative 5 d were observed and compared between the two groups;the blood glucose control,adverse reactions during treatment and hospital mortality rate on postoperative 7 d were compared between the two groups.Results The peripheral blood Gln level,TLC counts,serum IgA,IgG,and IgM levels on postoperative 1 d had no statistically significant difference between the two groups(P>0.05).Compared with postoperative 1 d,the peripheral blood Gln level,TLC count and serum IgA,IgG,IgM levels on postoperative 5 d in the observation group were significantly increased,moreover which in the observation group were significantly higher than those in the control group(P<0.05);the urine L/M ratio and plasma DAO value on postoperative 1 d had no statistical difference between the two groups(P>0.05);the urine L/M ratio on postoperative 5 d in the observation group had no statistical difference compared with that on postoperative 1 d(P>0.05),and the blood DAO level was significantly reduced(P<0.05);the urine L/M ratio and blood DAO level in the control group were significantly increased and higher than those in the observation group(P<0.05);there was no statistically significant difference in the time of blood glucose reaching the standard and the insulin use amount after operation between the two groups(P>0.05);the main adverse reactions of the two groups were steatorrhea,abdominal distension,abdominal pain and liver disease related to parenteral nutrition support.No cases were found to have shock or death due to complications.The adverse reaction rate during treatment in the observation group was significantly lower than that in the control group(23.64%vs.41.82%,χ^(2)=12.017,P<0.001).There was no statistically significant difference in the nosocomial disease all-factor mortality rate of the patients(5.45%vs.7.25%,χ^(2)=1.032,P=0.695).Conclusion The Ala-Gln injection therapy can maintain postoperative plasma Gln level in the patients with pancreatic cancer resection,improve the immune indexes,maintain the intestinal permeability and have good safety,which is conducive to the postoperative recovery of the patients.
作者
牛旭
刘靖
张冬茜
NIU Xu;LIU Jing;ZHANG Dongqian(Department of General Surgery,Affiliated Beijing Luhe Hospital,Capital Medical University,Beijing 101199,China;Department of General Surgery,Affiliated Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of General Surgery,Tangshan Municipal People’s Hospital,Tangshan,Hebei 063001,China)
出处
《重庆医学》
CAS
2022年第15期2596-2599,2604,共5页
Chongqing medicine
基金
河北省2020年度医学科学研究课题计划项目(20201536)。
关键词
胰腺癌
丙氨酰谷氨酰胺
谷氨酰胺双肽
免疫功能
肠道通透性
pancreatic cancer
alanyl glutamine
glutamine dipeptide
immune function
intestinal permeability
