王卉 边浩鹏 程琦

[摘要] 目的 探讨谷氨酰胺对肝癌切除术患者炎性反应及肺损傷的影响。 方法 选择2014年1月～2017年1月石家庄市第一医院中心院区收治的101例肝癌患者，按照随机数字表法分为对照组和治疗组，其中对照组50例、治疗组51例。两组患者均给予肝脏肿瘤切除术，治疗组予谷氨酰胺治疗，对照组予等量生理盐水，两组患者均治疗7 d。检测并比较两组治疗前后血清白细胞介素-1（IL-1）、肿瘤坏死因子-α（TNF-α）、谷丙转氨酶（ALT）、谷草转氨酶（AST）和外周血CD3+、CD4+、CD8+细胞所占比值。评价并比较两组治疗前后的Murray肺损伤评分（MLIS）和急性生理与慢性健康（APACHE Ⅱ）评分。 结果 治疗后，两组血清IL-1、TNF-α水平均低于治疗前，且治疗组低于对照组（P < 0.05）。治疗后，两组MLIS评分、APACHE Ⅱ评分均低于治疗前，且治疗组低于对照组（P < 0.05）。治疗后，两组血清ALT、AST水平均高于治疗前，然而治疗组血清ALT、AST水平均明显低于对照组（P < 0.05）。治疗后，两组外周血CD3+、CD4+细胞所占比值均高于治疗前，两组外周血CD8+细胞所占比值均低于治疗前，且治疗组外周血CD3+、CD4+、CD8+细胞所占比值变化均优于对照组（P < 0.05）。 结论 肝癌切除术患者应用谷氨酰胺，能够明显抑制炎性反应，减轻肺损伤程度，改善肝功能和机体免疫功能，值得在临床上推广应用。

[关键词] 肝癌切除术；谷氨酰胺；炎性反应；肺损伤；肝功能；免疫功能

[中图分类号] R735 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0079-04

[Abstract] Objective To study the effect of the Glutamine on inflammatory response and lung injury in liver cancer patients after the hepatectomy. Methods A total of 101 liver cancer patients after the hepatectomy in Central Hospital， the First Hospital of Shijiazhuang City from January 2014 to January 2017 were selected and they were divided into the control group （n = 50） and the treatment group （n = 51） according to random number table method. The treatment group was treated with Glutamine， and the control group was treated with normal saline in the same volume. Both groups were treated for 7 days. The serum Interleukin-1 （IL-1）， tumor necrosis factor-α （TNF-α）， glutamic-pyruvic transaminase （ALT）， glutamic oxalacetic transaminase （AST） and proportion of peripheral blood CD3+， CD4+， CD8+ of the two groups were compared before and after treatment. The MLIS and APACHE Ⅱ scores of the two groups were compared before and after treatment. Results After treatment， the levels of serum IL-1， TNF-α of the two groups were significantly lower than those before treatment， and those of the treatment group were significantly lower than the control group （P < 0.05）. After treatment， the MLIS and APACHE II scores of the two groups were significantly lower than those before treatment， and scores of the treatment group were significantly lower than the control group （P < 0.05）. After treatment， the serum ALT， AST of the two groups were significantly higher than those before treatment， while the indices of the treatment group were significantly lower than the control group （P < 0.05）. After treatment， the proportions of peripheral blood CD3+， CD4+ of the two groups were significantly higher than those before treatment， the proportion of peripheral blood CD3+， CD4+， CD8+ of the two groups were significantly lower than those before treatment， and the changes of the treatment group were significantly better than the control group （P < 0.05）. Conclusion Application of Glutamine in liver cancer patients with hepatectomy， can inhibit the inflammatory response， reduce the lung injury degree， improve the liver and immune function， and it is worthy clinical promotion.

[Key words] Hepatectomy of liver cancer； Glutamine； Inflammatory response； Lung injury； Liver function； Immune function

肝癌是一種临床常见的恶性肿瘤，主要是由结直肠、胆道、胰腺、乳腺等器官恶性肿瘤的肝转移所致，具有发病率高、危害性大的特点[1]。目前临床治疗原发性肝癌主要采用肝癌切除术进行治疗，但是术后患者往往有不同程度的肝功能损害，使术后切口感染裂开、膈下积液等并发症的发生率增大。另外手术的操作中需要阻断肝门，有诱发缺血-再灌注损伤的风险，严重者会引起急性肺损伤[2]。谷氨酰胺是一种大量存在于人体细胞和血浆中的氨基酸，不仅是核酸、蛋白质等物质合成所必需的前体，还是细胞增生所必需的能源物质，参与酸碱平衡的调节[3]。有文献报道[4]，谷氨酰胺具有抗氧化和肺保护的作用，还能促进肠道黏膜的修复、巨噬细胞的分化和淋巴细胞的增殖，从而调节机体免疫功能。……