摘要
目的观察免疫制剂谷氨酰胺对有营养风险肝切除术患者肝功能、淋巴细胞计数及C反应蛋白的影响。方法采用队列研究的方法，连续定点采集2011年1月至2015年12月于广州军区武汉总医院行肝切除术的患者，用营养风险筛查工具NRS2002评分标准，对NRSI〉3分的患者纳人研究。观察并分析肝切除术患者术前、术后3、7d谷丙转氨酶（AST）、谷草转氨酶（ALT）、白蛋白（ALB）、前白蛋白（PAB）、胆碱酯酶（CHE）和淋巴细胞计数（LY）、C反应蛋白（CRP）以及术后感染性并发症发生率和住院天数等临床结局指标。结果筛选出符合研究条件的患者143例，Gln组84例，对照组59例。两组肝功能相关指标ALT、AST、ALB、PAB、CHE比较，术前，术后3d差异均无统计学意义（P=0．833，0．661，0．326，0．453，0．276）。术后7d，两组AST、CHE比较差异无统计学意义。术后7d，Gin组ALT、ALB、PAB[（54．5±38．0）U／L、（38．2±4．3）g／L、（175．7±17．6）mg／L]与对照组[（71．1±55．9）U／L、（34．6±5．2）g／L、（156．4±21．9）mg／L]比较差异有统计学意义（t=-2．116，4．503，5．827，P=0．036，0．019，0．001）。Gln组与对照组CRP、LY术前，术后3d比较，差异均无统计学意义（P=0．173，0．248）。术后7d，Gln组CRP[（32．4±15．4）mg／L]与对照组[（59．5±21．4）mg／L]比较差异有统计学意义（t=-6．180，P=0．012）。两组术后7dLY比较差异无统计学意义（t=2．558，P=0．124）。Gln组和对照组患者感染性并发症发生例数分别为3、7例（x^2=．665，P=0．056），平均住院天数分别为（11．44±4．48）、（13．60±6．10）d（t=-2．439，P=0。016）。结论Gln免疫制剂有益于缓解肝切除术患者术后急性炎性反应，提升肝功能及淋巴细胞计数，减少感染性并发症发生率，缩短住院时间，改善患者预后。
Objective To evaluate the impact of glutamine nutritional support on liver function, immune function in postoperative patients after hepatectomy. Methods The clinical data of patients who have been subjected to the hepatectomy in general surgery of hospital of Guangzhou Military Command from January 2011 to December 2015 were continuously collected. The enrolled patients included those with NRS±〉3, graded by NRS2002 scoring criteria. The liver function （AST, ALT, ALB, PAB, and CHE）, C -reactive protein （CRP） and lymphocyte count （LY） were measured on the preoperative day and postoperative day 5, 7. The hospital stay and incidence of infectious complications were observed. Results 143 cases of patients in total were included in this study, and 84 cases were given glutamine treatment and 59 cases were not. The levels of ALT, ALB and PAB at postoperative day 7 were （54. 5 ± 38.0） U/L, （38.2 ± 4. 3 ） g/L and （ 175.7 ± 17. 6） mg/L respectively, which were significantly higher than （71.1 ± 55.9） U/L, （34.6 ±5.2） g/L and （156.4 ±21.9） mg/L in the control group （t= -2. 116, 4.503, 5. 827, P =0. 036, 0. 019, 0. 001）. There was no significant difference in the levels of AST and CHE be- tween the experimental group and the control group at postoperative day 7. The levels of CRP at postoperative day 7 were （32. 4 ± 15.4） rag/L, Which were significantly higher than （59. 5 ± 21.4） mg/L in the control group （t = -6. 180,P =0. 012）. There was no significant difference in the levels of LY between the experi- mental group and the control group at postoperative day 7. There were 3 cases of infectious complication in the experimental group, and 7 cases in the control group, respectively （ P = 0. 056）. The hospital stay was （11.44±4. 48） and （13.60 ± 6. 10） days in the experimental group and control group （t = -2. 439 ,P = 0. 016）. Conclusion Gin nutritional support can significantly improve liver function and immune function, reduce the incidence of infectious complication, and shorten the hospital stay for patients after hepatectomy.
出处
《中华实验外科杂志》
CSCD
北大核心
2017年第6期1027-1030,共4页
Chinese Journal of Experimental Surgery
基金
国家自然科学基金（81170420）
关键词
谷氨酰胺
肝切除术
营养风险
肝功能
免疫功能
Glutamine
Hepatectomy
Nutritional risk
Liver function
Immune function
