Hulsewé Karel W E, van der Hulst Rene W W J, van Acker Bernadette A C, von Meyenfeldt Maarten F, Soeters Peter B
Department of General surgery, Academic Hospital Maastricht, The Netherlands.
Clin Nutr. 2004 Oct;23(5):1209-16. doi: 10.1016/j.clnu.2004.04.001.
Nutritional depletion has been correlated with low plasma and mucosal glutamine concentrations and with increased intestinal permeability. Since nutritional depletion often is associated with (chronic) inflammatory stress, this study was designed to establish the influence of depletion and inflammation on glutamine concentrations and gut barrier function.
Anthropometric parameters were calculated from 26 patients who required artificial nutrition. Glutamine concentrations in plasma and gut mucosa, gut permeability and mucosal morphology were assessed. For determination of the degree of inflammation erythrocyte sedimentation rates and (pre)albumin concentrations were measured. On the basis of these parameters patients were divided into two groups having significant inflammatory stress or not. Similarly, a depleted and a non-depleted group was formed based on percentage ideal body weight, fat-free mass index (FFMI) and percentage weight loss. Glutamine concentrations, gut permeability and villus morphology were compared between the groups.
The presence of inflammatory activity had significant negative effects on glutamine concentrations in contrast to the presence or absence of nutritional depletion. Similarly, intestinal permeability increased during active inflammation but not in depleted patients. FFMI but not inflammation was related to villus height.
The presence of inflammation significantly affects glutamine concentrations and gut permeability, in contrast to the presence of depletion of body cell mass per se. On the other hand, villus morphology is not influenced by changes in systemic inflammatory activity whereas nutritional status possibly does affect villus height.
营养耗竭与血浆和黏膜谷氨酰胺浓度降低以及肠道通透性增加相关。由于营养耗竭常与（慢性）炎症应激相关，本研究旨在确定耗竭和炎症对谷氨酰胺浓度及肠道屏障功能的影响。
对26例需要人工营养的患者计算人体测量学参数。评估血浆和肠道黏膜中的谷氨酰胺浓度、肠道通透性及黏膜形态。为测定炎症程度，检测红细胞沉降率和（前）白蛋白浓度。根据这些参数，将患者分为有显著炎症应激和无显著炎症应激两组。同样，根据理想体重百分比、去脂体重指数（FFMI）和体重减轻百分比，将患者分为营养耗竭组和非营养耗竭组。比较两组之间的谷氨酰胺浓度、肠道通透性和绒毛形态。
与营养耗竭的有无相比，炎症活动的存在对谷氨酰胺浓度有显著负面影响。同样，在炎症活动期肠道通透性增加，而在营养耗竭患者中未增加。FFMI而非炎症与绒毛高度相关。
与身体细胞质量本身的耗竭相比，炎症的存在显著影响谷氨酰胺浓度和肠道通透性。另一方面，绒毛形态不受全身炎症活动变化的影响，而营养状况可能确实会影响绒毛高度。
