标题：谷氨酰胺强化肠内营养支持在老年晚期胃癌患者中的应用

      作者：德琳，龙鹤，张左雅介    中国人民解放军北部战区空军医院医学营养科，辽宁 沈阳 110046

      卷次： 2020年31卷14期

      【摘要】 目的 探讨谷氨酰胺强化肠内营养支持对老年晚期胃癌患者营养指标、免疫功能和生活质量的影响。方法 选取2017年3月至2019年5月在中国人民解放军北部战区空军医院医学营养科就诊的老年晚期胃癌患者80例进行研究，采用随机数表法将患者均分为观察组和对照组，每组40例。对照组患者实施常规营养支持，观察组患者实施谷氨酰胺强化肠内营养支持。比较两组患者治疗前及治疗2周后的营养指标、胃肠激素水平、免疫功能、生活质量及血清炎性因子水平。结果 治疗前，两组患者的营养指标、胃肠激素水平、免疫功能、生活质量评分及血清炎性因子水平比较差异均无统计学意义(P>0.05)；治疗2周后，观察组患者的红细胞、血清白蛋白、血清前白蛋白水平[(4.29±1.01)×1012/L、(33.42±3.09) g/L、(194.83±14.12) mg/L]明显高于对照组[(3.58±1.02)×1012/L、(28.71±3.10) g/L、(176.52±14.13) mg/L]，血清胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ、促胃液素水平[(94.73±12.15) μg/L、(20.93±2.22) μg/L、(23.75±2.01) ng/L]明显高于对照组[(86.09±12.14) μg/L、(17.61±2.23) μg/L、(19.83±2.02) ng/L]，差异均有统计学意义(P<0.05)；治疗2周后观察组患者的免疫球蛋白G、免疫球蛋白A、免疫球蛋白M水平[(11.29±1.77) g/L、(3.18±0.95) g/L、(1.62±0.38) g/L]明显高于对照组[(9.14±1.78) g/L、(2.52±0.96) g/L、(1.30±0.37) g/L]，心理卫生、躯体功能、健康程度、情绪角色评分[(76.25±7.57)分、(73.48±6.23)分、(80.97±5.10)分、(78.31±6.37)分]明显高于对照组[(65.38±7.52)分、(65.79±6.22)分、(74.55±5.09)分、(70.92±6.34)分]，而C反应蛋白(CRP)、白介素-6 (IL-6)、白介素-10 (IL-10)水平[(45.27±5.72) mg/dL、(32.19±1.12) pg/mL、(13.61±1.07) pg/mL]明显低于对照组[(50.23±5.71) mg/dL、(36.46±1.13) pg/mL、(17.92±1.08) pg/mL]，差异均有统计学意义(P<0.05)。结论 谷氨酰胺强化肠内营养支持能有效改善老年晚期胃癌患者的营养指标，提高患者的胃肠及免疫功能，降低患者的血清炎症因子水平，进而提升患者的生活质量，值得临床推广。
      【关键词】 胃癌；晚期；营养支持；谷氨酰胺；营养指标；免疫功能；疗效；生活质量
      【中图分类号】 R735.2 【文献标识码】 A 【文章编号】 1003—6350（2020）14—1793—04

Application of glutamine-enhanced enteral nutrition in elderly patients with advanced gastric cancer.
DE Lin,LONG He, ZHANG-ZUO Ya-jie. Department of Medical Nutrition, Air Force Hospital of Northern Theater of PLA, Shenyang110046, Liaoning, CHINA
【Abstract】 Objective To explore the effects of glutamine-enhanced enteral nutrition support on nutritional in-dicators, immune function, gastrointestinal hormones and inflammatory factors in elderly patients with advanced gastriccancer. Methods A total of 80 elderly patients with advanced gastric cancer, who admitted to Department of MedicalNutrition, Air Force Hospital of Northern Theater of PLA from March 2017 to May 2019, were selected and divided intothe observation group and control group according to random number table method, with 40 patients in each group. The pa-tients in the control group were given routine nutritional support, and patients in the observation group received glutamineenhanced enteral nutrition support. The nutritional indexes, gastrointestinal hormone levels, immune function, quality oflife scores and serum inflammatory factor levels of the two groups of patients before and after treatment for 2 weeks werecompared. Results Before treatment, there was no significant difference in the nutritional indicators, gastrointestinal hor-mone levels, immune function, quality of life scores and serum inflammatory factors between the two groups (all P>0.05).After 2 weeks of treatment, the erythrocyte, serum albumin, and serum prealbumin levels in the observation group were(4.29±1.01)×1012/L, (33.42±3.09) g/L, (194.83±14.12) mg/L, respectively, which were significantly higher than correspond-ing (3.58±1.02)×1012/L, (28.71±3.10) g/L, (176.52±14.13) mg/L in the control group; the levels of serum pepsinogen Ⅰ,