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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白细胞介素-1(IL-1)、血清肿瘤坏死因子-α(TNF-α)水平及急性肺损伤(ALI)的影响。方法 90例肝癌患者作为研究对象,所有患者均行肝脏肿瘤切除术,按就诊单双号分为观察组与对照组,每组45例。所有患者均行肝脏肿瘤切除术,并给予机械通气、营养支持、液体管理等常规治疗,同时观察组给予0.4 g/(kg·d)谷氨酰胺治疗,对照组给予等量的生理盐水作为安慰剂。于治疗前后,对比两组IL-1、TNF-α水平并观察肝功能指标[门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)]变化,同时记录Murray肺损伤评分(MLIS)及急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。结果治疗前两组IL-1、TNF-α水平比较差异无统计学意义(P>0.05);治疗后两组IL-1、TNF-α水平均较本组治疗前明显降低(P<0.05),且观察组下降趋势更明显(P<0.05)。治疗前两组ALT、AST水平比较差异无统计学意义(P>0.05);治疗后两组ALT、AST水平均较本组治疗前升高(P<0.05),但观察组上升趋势明显小于对照组(P<0.05)。治疗前,观察组MLIS量表评分(2.06±0.61)分、APACHEⅡ评分(16.15±4.30)分,对照组分别为(1.95±0.70)、(15.92±4.56)分,两组比较差异无统计学意义(P>0.05);治疗后,观察组MLIS量表评分(0.95±0.31)分、APACHEⅡ评分(8.15±2.30)分,对照组分别为(1.51±0.30)、(11.38±2.56)分,治疗后观察组与对照组MLIS量表评分、APACHEⅡ评分均明显优于治疗前(P<0.05),且观察组均优于对照组(P<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 the levels of interleukin-1 (IL-1), serum tumor necrosis factor-α (TNF-α) and acute lung injury (ALI) in patients undergoing hepatectomy. Methods Totally 90 patients with hepatocellular carcinoma (HCC) were enrolled in this study. All patients underwent hepatectomy. The patients were divided into observation group and control group according to the single and double numbers. 45 patients in each group. All patients underwent hepatectomy and were given conventional therapy such as mechanical ventilation, nutrition support and fluid management. The observation group was given glutamine 0.4 g / (kg · d), while the control group was given the same amount of saline as the comfort Agent. Before and after treatment, the levels of IL-1 and TNF-α in both groups were compared and the change of hepatic function indicators (aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] were observed. Murray lung injury score (MLIS) and acute physiology and chronic health assessment score Ⅱ (APACHE Ⅱ) score. Results There was no significant difference in the levels of IL-1 and TNF-α between the two groups before treatment (P> 0.05). The levels of IL-1 and TNF-α in the two groups were significantly lower than those before treatment (P <0.05) , And the decline trend of the observation group was more obvious (P <0.05). The levels of ALT and AST in the two groups before treatment were not significantly different (P> 0.05). The levels of ALT and AST in both groups were significantly higher than those before treatment (P <0.05), but the increasing trend in the observation group was significantly less than that in the control group Group (P <0.05). Before treatment, MLIS scale score (2.06 ± 0.61) and APACHEⅡ score (16.15 ± 4.30) in the observation group were (1.95 ± 0.70) and (15.92 ± 4.56) points respectively in the observation group, with no significant difference between the two groups (P> 0.05). After treatment, the MLIS scale score (0.95 ± 0.31) and APACHEⅡ score (8.15 ± 2.30) in the observation group and (1.51 ± 0.30) and (11.38 ± 2.56) The observation group and control group MLIS scale score, APACHE Ⅱ score were significantly better than before treatment (P <0.05), and the observation group were better than the control group (P <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.