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目的探析谷氨酰胺对肝脏肿瘤切除术患者细胞因子血清白细胞介素1(IL-1)、肿瘤坏死因子α(TNF-α)水平及急性肺损伤(ALI)的影响。方法选择2014年11月至2016年5月收治的90例肝癌患者,均行肝脏肿瘤切除术,按就诊编号分为两组,观察组(n=45,静脉给予0.4 g·kg~(-1)·d~(-1)谷氨酰胺治疗)及对照组(n=45,给予等量的生理盐水作为安慰剂)。于治疗前、治疗7 d后,对比两组IL-1、TNF-α水平及急性生理和慢性健康评分(APACHEⅡ)、Murray肺损伤评分(MLIS)情况,并观察手术前后两组患者肝功能指标[门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)]变化。结果治疗7 d后两组IL-1、TNF-α水平及MLIS及APACHEⅡ评分均较本组治疗前明显降低,且观察组优于对照组,差异有统计学意义(P均<0.05);治疗后两组ALT、AST水平均较本组治疗前升高,且观察组优于对照组,差异有统计学意义(P均<0.05)。结论给予行肝脏肿瘤切除术的肝癌患者谷氨酰胺治疗有利于降低血清细胞因子水平,抑制炎症反应,改善肝功能指标,减轻肺损伤程度。
Objective To investigate the effects of glutamine on serum levels of interleukin 1 (IL-1), tumor necrosis factor-α (TNF-α) and acute lung injury (ALI) in patients undergoing liver resection. Methods Totally 90 patients with liver cancer who were treated from November 2014 to May 2016 were enrolled in this study. All patients underwent hepatectomy. The patients in the observation group were divided into two groups. The observation group (n = 45, 0.4 g · kg -1 ) · D ~ (-1) glutamine treatment) and control group (n = 45, an equal amount of saline as placebo). Before treatment, the levels of IL-1, TNF-α, APACHEⅡ and Murray’s Lung Injury Score (MLIS) were compared between the two groups after 7 days of treatment. The liver function indexes [Aspartate aminotransferase (AST), alanine aminotransferase (ALT)] changes. Results After 7 days of treatment, the levels of IL-1, TNF-α and MLIS and APACHEⅡ in both groups were significantly lower than those in the control group before treatment, and the difference between the two groups was statistically significant (all P <0.05) After two groups of ALT, AST levels were higher than the group before treatment, and the observation group was better than the control group, the difference was statistically significant (P all <0.05). Conclusions Glutamine treatment in patients with liver cancer undergoing liver tumor resection is beneficial to lower serum cytokine levels, inhibit the inflammatory response, improve liver function and reduce the degree of lung injury.