谷氨酰胺对胃癌术后化疗患者肠屏障功能的影响

目的观察谷氨酰胺对胃癌术后化疗患者肠屏障功能的影响。方法40例胃癌术后第4次化疗患者随机分为对照组和试验组,化疗方案为氟尿嘧啶(5-FU)、四氢叶酸(CF)加奥沙利铂(FOLFOX方案)。试验组化疗同时口服谷氨酰胺(30g/d),对照组化疗时未口服谷氨酰胺,检测两组患者化疗前后血浆谷氨酰胺浓度、二胺氧化酶(DAO)、D-乳酸水平及粪便中肠道菌群情况。结果化疗后对照组血浆谷氨酰胺浓度较化疗前明显降低(P0.05),试验组增加并明显高于对照组(P0.01);化疗后两组血浆DAO水平较化疗前均明显升高(P0.01),对照组较试验组升高更为明显(P0.05);对照组D-乳酸水平化疗后升高(P0.05),与试验组比较差异有统计学意义;试验组患者各肠道菌群总数化疗前后无明显变化,肠道菌群接近正常比例;对照组双歧杆菌、乳杆菌较化疗前明显下降(P0.01),大肠埃希菌、肠球菌明显升高(P0.01)。结论口服谷氨酰胺可提高胃癌术后化疗患者血浆谷氨酰胺浓度,有减轻损伤、调节肠道菌群微生态平衡、保护肠屏障功能的作用。

Effects of glutamine on intestinal barrier function in patients undergoing postoperative chemotherapy for gastric cancer

Objective To study the effects ofglutamine on intestinal barrier function in patients undergoing postoperative chemotherapy for gastric cancer. Methods Forty patients with gastric cancer after operation who accepted the fourth chemotherapy were randomly divided into Gin group and control group. The former received oral administration of glutamine （30 g/d） for 7 days. All patients received CF＋5-FU＋Oxalipatin chemotherapy, namely FOLFOX formula, for 5 days. Serum concentration of glutamine, DAO and D-lactate were measured before and 1 day after chemotherapy. Changes of microflora in stool were also studied by bacterial culture. Results After chemotherapy, the serum concentration of glutamine was significantly decreased in the control group（P〈0.05） and increased in the Gin group（P〈0.01）, and there was significant difference between the two groups（P〈0.01）. The levels of DAO in the two groups after chemotherapy were significantly higher than those before treatment（P〈0.01）, while they were significantly higher in the control group than those in the Gin group（P〈0.05）. The levels of D-lactate in the control group were significantly higher than those in the Gin group（P〈0.05）. Bacterial culture revealed that the amount of bifidobaterium and lactobacilh were markedly increased while escherichia coli and enterococcus faecalis decreased in the control group. Conclusion Oraladministrationofglutaminecanincreaseserumconcentration of glutamine in chemotherapy patients with gastric cancer and shows the protective effects on gut barrier function by alleviating the damage of intestinal mucosa and microecologic disturbance.