谷氨酰胺对术后早期肠道通透性变化的影响及其与全身炎症反应的关系。
Effect of glutamine on change in early postoperative intestinal permeability and its relation to systemic inflammatory response.
作者信息
Quan Zhu-Fu, Yang Chong, Li Ning, Li Jie-Shou
机构信息
Research Institute of General Surgery, Jinling Hospital, Medical College of Nanjing University, Nanjing 210002, Jiangsu Province, China.
出版信息
World J Gastroenterol. 2004 Jul 1;10(13):1992-4. doi: 10.3748/wjg.v10.i13.1992.
AIM
To study the effects of glutamine (Gln) on the change of intestinal permeability and its relationship to systemic inflammatory response in early abdominal postoperative patients.
METHODS
A prospective, randomized, double-blind and controlled trial was taken. Twenty patients undergoing abdominal surgery were randomized into Gln group (oral administration of glutamine, 30 g/d, for 7 d, n=10) and placebo group (oral administration of placebo, 30 g/d, for 7 d, n=10). Temperatures and heart rates of all patients were daily recorded. White blood cell counts(WBC) and biochemical variables were measured before operation and 4 and 7 d after drug administration. Serum concentrations of glutamine, endotoxin, diamine oxidase and malondialdehyde and urine lactulose/mannito (L/M) ratio were measured before and 7 d after drug administration.
RESULTS
The patients in the 2 groups were comparable prior to drug administration. Serum Gln concentration was significantly decreased in the placebo group and increased in the Gln group 7 d after drug administration. Urine L/M ratio was significantly increased in the placebo group and decreased in the Gln group. The serum concentration of endotoxin, diamine oxidase and malondialdehyde was significantly decreased in the Gln group compared with those in the placebo group. Temperatures, heart rates and WBC counts were significantly lower in the Gln group than those in the placebo group.
CONCLUSION
Gut is one of the sources of systemic inflammatory response in abdominal postoperative patients and glutamine can decrease intestinal permeability, maintain intestinal barrier and attenuate systemic inflammatory response in early postoperative patients.
目的
研究谷氨酰胺（Gln）对腹部手术后早期患者肠道通透性变化的影响及其与全身炎症反应的关系。
方法
采用前瞻性、随机、双盲、对照试验。20例接受腹部手术的患者被随机分为谷氨酰胺组（口服谷氨酰胺，30 g/d，共7天，n = 10）和安慰剂组（口服安慰剂，30 g/d，共7天，n = 10）。每天记录所有患者的体温和心率。在手术前及给药后4天和7天测量白细胞计数（WBC）和生化指标。在给药前及给药后7天测量血清谷氨酰胺、内毒素、二胺氧化酶和丙二醛浓度以及尿乳果糖/甘露醇（L/M）比值。
结果
两组患者在给药前具有可比性。给药7天后，安慰剂组血清谷氨酰胺浓度显著降低，谷氨酰胺组升高。安慰剂组尿L/M比值显著升高，谷氨酰胺组降低。与安慰剂组相比，谷氨酰胺组血清内毒素、二胺氧化酶和丙二醛浓度显著降低。谷氨酰胺组的体温、心率和WBC计数显著低于安慰剂组。
结论
肠道是腹部手术后患者全身炎症反应的来源之一，谷氨酰胺可降低肠道通透性，维持肠道屏障，并减轻术后早期患者的全身炎症反应。
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