目的 伊立替康的主要剂量依赖性毒副反应是骨髓抑制和胃肠道不良反应，特别是不可预测的严重腹泻。本研究 的目的在于评价奥曲肽联合丙氨酰谷氨酰胺预防伊立替康导致大肠癌患者迟发性腹泻的临床作用。方法 选取本院 2015 年 1 月至 12 月期间接受 FOLFIRI 方案化疗的晚期结直肠癌患者 60 例，分为预防组（n=30）及对照组（n=30）。预防组于化 疗当日开始给予奥曲肽 0.1mg tid 皮下注射及丙氨酰谷氨酰胺 10g qd ivgtt，连续应用 6 天，对比两组患者迟发性腹泻发生率 及严重程度。两组患者出现稀便或便次增多时，均开始给予大剂量洛哌丁胺治疗，必要时给予蒙脱石散、双歧杆菌胶囊止 泻并给予对症补液治疗。结果 对照组患者 12 例发生迟发性腹泻，发生率为 40%，其中 2 级腹泻 6 例（20%），3 级腹 泻 4 例（13.3%），4 级腹泻 2 例（6.7%）。预防组患者 4 例发生迟发性腹泻，发生率为 13.3%（P<0.05），且均为 2 级腹泻， 无 3~4 级腹泻发生。结论 奥曲肽联合丙氨酰谷氨酰胺对伊立替康导致的迟发性腹泻有良好的预防作用，可以提高伊立替康 使用的安全性。

Objective The gastrointestinal side effects and bone marrow suppression are main dose dependent toxicity of irinotecan, especially the unpredictable severe diarrhea. This study aimed to assess the clinical effect of octreotide combined with alanyl-glutamine on the prevention of irinotecan-caused tardive diarrhea in patients with colorectal cancer. Methods Sixty patients with advanced colorectal cancer who were scheduled irinotecan-based -chemotherapy were recruited and divided into prevention group (n=30) and control group (n=30). Patients in prevention group received octreotide 0.1mg tid via hypodermic injection and alanyl-glutamine10g qd ivgtt from the onset of chemotherapy to day 6. The incidence and severity of tardive diarrhea in both groups were compared. The large doses of loperamide amine were used to treat when patients with sparse stool or the increase in time. The montmorillonite powder, Bifidobacterium capsule and rehydration therapy were given when necessary. Results There were 12 cases with tardive diarrhea in control group with the incidence of 40%, including 6 cases (20%) of grade 2 diarrhea, 4 cases (13.3%) of grade 3 diarrhea, and 2 cases (6.7%) of grade 4 diarrhea. 4 cases occurred tardive diarrhea in prevention group with the incidence of 13.3% (P<0.05), and all of them were grade 2 diarrhea, and no grade 3~4 diarrhea occurred. Conclusions There were good preventive effect of octreotide combined with alanyl-glutamineon irinotecan-caused tardive diarrhea, which could improve the safety.