丙氨酰-谷氨酰胺强化营养支持治疗腹型过敏性紫癜患儿的临床研究
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摘要
目的了解丙氨酰-谷氨酰胺强化营养支持对于腹型过敏性紫癜患儿的临床有效性。方法将需要营养支持的腹型过敏性紫癜患儿依据年龄、性别、病情进行分层,随机分为对照组(n=118)和强化营养组(n=107)。对照组未使用丙氨酰-谷氨酰胺,强化营养组使用丙氨酰-谷氨酰胺,根据病情给予静脉激素,其余治疗相同。比较两组患儿住院总时间、静脉激素使用率和时间、住院期间症状有无反复、全静脉营养使用率、体重降低发生率、禁食>5 d比例;并在出院后随访3个月,了解症状有无复发。结果两组住院总时间、全静脉营养使用率、禁食>5 d比例比较差异无统计学意义(P>0.05);对照组静脉激素的使用比例和时间、症状反复、体重下降比例均高于强化营养组(P<0.05)。出院后随访3个月,所有患儿均恢复了正常饮食,两组消化道症状复发率均小于20%,主要以腹痛为主要表现(83.33%,30/36),其次为呕吐和腹胀,无消化道出血表现,予以对症治疗可缓解,两组间消化道症状复发率比较差异无统计学意义(P=0.693)。结论丙氨酰-谷氨酰胺强化营养支持治疗腹型过敏性紫癜患儿能够减少静脉激素的使用,降低体重的下降,但是对住院总时间和出院后复发无影响。
Objective To study the clinical effect of alanyl-glutamine-enriched nutritional support in the treatment of children with abdominal Henoch-Sch?nlein purpura. Methods Children with abdominal Henoch-Sch?nlein purpura who needed nutritional support were enrolled and stratified according to age, sex and the severity of disease, and were randomly divided into a control group(n=118) and an enriched nutritional support group(n=107). The control group was given nutritional support without using alanyl-glutamine, while the enriched nutritional support group was given alanyl-glutamine-enriched nutritional support. Intravenous steroids were used according to the severity of disease in both groups. Other therapies were the same in the two groups. The two groups were compared in terms of the length of hospital stay, the rate and duration of use of intravenous steroids, the recurrence rate of symptoms during hospitalization, the rate of total parenteral nutrition(TPN), the rate of weight loss and the rate of fasting for more than 5 days. All patients were followed up for 3 months after discharge to monitor the recurrence of symptoms. Results There were no significant differences in the length of hospital stay, the rate of TPN and the rate of fasting for more than 5 days between the two groups(P>0.05). Compared with the enriched nutritional support group, the control group showed significant increases in the rate and duration of use of intravenous steroids, the recurrence rate of symptoms and the rate of weight loss(P<0.05). After the 3-month follow-up, all the children resumed normal diet, and the recurrence rate of digestive symptoms was less than 20% in each group. Abdominal pain was the most common symptom(83.33%, 30/36), followed by vomiting and abdominal distention. No digestive hemorrhage was observed. All the symptoms were relieved after symptomatic treatment. No significant difference was found between the two groups in the recurrence rate of digestive symptoms(P=0.693). Conclusions Alanyl-glutamine-enriched nutritional support in the treatment of children with abdominal Henoch-Sch?nlein purpura can reduce the use of intravenous steroids and weight loss, but without impact on the length of hospital stay and post-discharge recurrence.
Objective To study the clinical effect of alanyl-glutamine-enriched nutritional support in the treatment of children with abdominal Henoch-Sch?nlein purpura. Methods Children with abdominal Henoch-Sch?nlein purpura who needed nutritional support were enrolled and stratified according to age, sex and the severity of disease, and were randomly divided into a control group(n=118) and an enriched nutritional support group(n=107). The control group was given nutritional support without using alanyl-glutamine, while the enriched nutritional support group was given alanyl-glutamine-enriched nutritional support. Intravenous steroids were used according to the severity of disease in both groups. Other therapies were the same in the two groups. The two groups were compared in terms of the length of hospital stay, the rate and duration of use of intravenous steroids, the recurrence rate of symptoms during hospitalization, the rate of total parenteral nutrition(TPN), the rate of weight loss and the rate of fasting for more than 5 days. All patients were followed up for 3 months after discharge to monitor the recurrence of symptoms. Results There were no significant differences in the length of hospital stay, the rate of TPN and the rate of fasting for more than 5 days between the two groups(P>0.05). Compared with the enriched nutritional support group, the control group showed significant increases in the rate and duration of use of intravenous steroids, the recurrence rate of symptoms and the rate of weight loss(P<0.05). After the 3-month follow-up, all the children resumed normal diet, and the recurrence rate of digestive symptoms was less than 20% in each group. Abdominal pain was the most common symptom(83.33%, 30/36), followed by vomiting and abdominal distention. No digestive hemorrhage was observed. All the symptoms were relieved after symptomatic treatment. No significant difference was found between the two groups in the recurrence rate of digestive symptoms(P=0.693). Conclusions Alanyl-glutamine-enriched nutritional support in the treatment of children with abdominal Henoch-Sch?nlein purpura can reduce the use of intravenous steroids and weight loss, but without impact on the length of hospital stay and post-discharge recurrence.
引文
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[12]董泾青,陈波,雷尚通,等.加用丙氨酰-谷氨酰胺静脉营养对小儿术后早期炎性肠梗阻的疗效评价[J].广东医学,2011,32(17):2322-2323.
[13]周倩兰,闻德亮.免疫营养在儿童炎症性肠病临床应用[J].中国实用儿科杂志,2012,27(9):708-710.
[14]Wang X,Pierre JF,Heneghan AF,et al.Glutamine improves innate immunity and prevents bacterial enteroinvasion during parenteral nutrition[J].JPEN J Parenter Enteral Nutr,2015,39(6):688-697.
[15]Jiang Q,Chen J,Liu S,et al.l-Glutamine attenuates apoptosis induced by endoplasmic reticulum stress by activating the IRE1α-XBP1 axis in IPEC-J2:a novel mechanism of l-glutamine in promoting intestinal health[J].Int J Mol Sci,2017,18(12):E2617.
[16]Kim MH,Kim H.The roles of glutamine in the intestine and its implication in intestinal diseases[J].Int J Mol Sci,2017,18(5):E1051.
[17]Alpers DH.Glutamine:do the data support the cause for glutamine supplementation in humans?[J].Gastroenterology,2006,130(2 Suppl 1):S106-S116.
[18]Mori M,Smedberg M,Klaude M,et al.A tracer bolus method for investigating glutamine linetics in humans[J].PLo S One,2014,9(5):e96601.
[2]Chen S,Xia Y,Zhu G,et al.Glutamine supplementation improves intestinal cell proliferation and stem cell differentiation in weanling mice[J].Food Nutr Res,2018,62:1439.
[3]He F,Wu C,Li P,et al.Functions and signaling pathways of amino acids in intestinal inflammation[J].Biomed Res Int,2018,2018:9171905.
[4]唐双意,邹小琴,杨玉芳,等.丙氨酰-谷氨酰胺在全合一肠外营养液中的稳定性[J].中国临床营养杂志,2006,14(3):163-166.
[5]中华医学会儿科学分会免疫学组.儿童过敏性紫癜循证诊治建议[J].中华儿科杂志,2013,51(7):502-507.
[6]Dao DT,Anez-Bustillos L,Cho BS,et al.Assessment of micronutrient status in critically ill children:challenges and opportunities[J].Nutrients,2017,9(11):E1185.
[7]Oldani M,Sandini M,Nespoli L,et al.Glutamine supplementation in intensive care patients:a meta-analysis of randomized clinical trials[J].Medicine(Baltimore),2015,94(31):e1319.
[8]van Zanten AR,Dhaliwal R,Garrel D,et al.Enteral glutamine supplementation in critically ill patients:a systematic review and meta-analysis[J].Crit Care,2015,19:294.
[9]袁贵龙,周守方,覃桂锋,等.谷氨酰胺防治早产儿喂养不耐受的临床应用[J].中国医药科学,2016,6(2):63-65.
[10]孟阳,朱玲玲.谷氨酰胺治疗新生儿坏死性小肠结肠炎的研究进展[J].东南大学学报(医学版),2015,34(1):163-166.
[11]肖建佳,王明峰,林连宗,等.谷氨酰胺预防早产儿坏死性小肠结肠炎的临床研究[J].中国新生儿科杂志,2012,27(1):51-52.
[12]董泾青,陈波,雷尚通,等.加用丙氨酰-谷氨酰胺静脉营养对小儿术后早期炎性肠梗阻的疗效评价[J].广东医学,2011,32(17):2322-2323.
[13]周倩兰,闻德亮.免疫营养在儿童炎症性肠病临床应用[J].中国实用儿科杂志,2012,27(9):708-710.
[14]Wang X,Pierre JF,Heneghan AF,et al.Glutamine improves innate immunity and prevents bacterial enteroinvasion during parenteral nutrition[J].JPEN J Parenter Enteral Nutr,2015,39(6):688-697.
[15]Jiang Q,Chen J,Liu S,et al.l-Glutamine attenuates apoptosis induced by endoplasmic reticulum stress by activating the IRE1α-XBP1 axis in IPEC-J2:a novel mechanism of l-glutamine in promoting intestinal health[J].Int J Mol Sci,2017,18(12):E2617.
[16]Kim MH,Kim H.The roles of glutamine in the intestine and its implication in intestinal diseases[J].Int J Mol Sci,2017,18(5):E1051.
[17]Alpers DH.Glutamine:do the data support the cause for glutamine supplementation in humans?[J].Gastroenterology,2006,130(2 Suppl 1):S106-S116.
[18]Mori M,Smedberg M,Klaude M,et al.A tracer bolus method for investigating glutamine linetics in humans[J].PLo S One,2014,9(5):e96601.