Lin Ming-Tsan, Kung Sung-Pao, Yeh Sung-Ling, Liaw Koung-Yi, Wang Ming-Yang, Kuo Ming-Liang, Lee Po-Houng, Chen Wei-Jao
Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan S. Road, Taipei, Taiwan, China.
World J Gastroenterol. 2005 Oct 21;11(39):6197-201. doi: 10.3748/wjg.v11.i39.6197.
Previous reports have shown that decrease in plasma glutamine (Gln) level following major surgery may contribute to the state of immunosuppression. Gln supplementation improves the depletion of body Gln pool, and may have indirect effect on reducing proinflammatory mediator release. This study evaluated whether the effect of Gln dipeptide-enriched total parenteral nutrition (TPN) on postoperative cytokine alteration depended on the disease severity of surgical patients.
Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228 g nitrogen/kg per d) and isocaloric (30 kcal/kg per d) TPN for 6 d. Control group (Conv) using conventional TPN solution received 1.5 g amino acids/kg per day, whereas the test group received 0.972 g amino acids/kg per day and 0.417 g L-alanyl-L-glutamine (Ala-Gln)/kg per day. Blood samples were collected on d 1 and d 6 postoperatively for plasma interleukin (IL)-2, IL-6, IL-8, and interferon (IFN)-gamma analysis.
Plasma IL-2 and IFN-gamma were not detectable. IL-6 concentrations were significantly lower on the 6(th) postoperative day in the Ala-Gln group than those in the Conv group in patients with APACHE II <=6, whereas no difference was noted in patients with APACHE II >6. There was no difference in IL-8 levels between the two groups. No difference in cumulative nitrogen balance was observed on d 2-5 after the operation between the two groups (Ala-Gln -3.2+/-1.6 g vs Conv -6.5+/-2.7 g). A significant inverse correlation was noted between plasma IL-6 levels and cumulative nitrogen balance postoperatively in the Ala-Gln group, whereas no such correlation was observed in the Conv group.
TPN supplemented with Gln dipeptide had no effect on plasma IL-8 levels after surgery. However, Gln supplementation had a beneficial effect on decreasing systemic IL-6 production after surgery in patients with low admission illness severity, and lower plasma IL-6 may improve nitrogen balance in patients with abdominal surgery when Gln was administered.
既往报道显示，大手术后血浆谷氨酰胺（Gln）水平降低可能导致免疫抑制状态。补充Gln可改善机体Gln储备的消耗，并可能对减少促炎介质释放有间接作用。本研究评估了富含Gln二肽的全胃肠外营养（TPN）对术后细胞因子改变的影响是否取决于手术患者的疾病严重程度。
48例接受腹部大手术的患者被分为两组，接受等氮（0.228 g氮/kg·d）和等热量（30 kcal/kg·d）的TPN治疗6天。对照组（Conv）使用传统TPN溶液，每天接受1.5 g氨基酸/kg，而试验组每天接受0.972 g氨基酸/kg和0.417 g L-丙氨酰-L-谷氨酰胺（Ala-Gln）/kg。术后第1天和第6天采集血样，进行血浆白细胞介素（IL）-2、IL-6、IL-8和干扰素（IFN）-γ分析。
血浆IL-2和IFN-γ无法检测到。在急性生理与慢性健康状况评分系统（APACHE）II≤6的患者中，Ala-Gln组术后第6天的IL-6浓度显著低于Conv组，而在APACHE II>6的患者中未观察到差异。两组之间的IL-8水平无差异。术后第2 - 5天，两组之间的累积氮平衡无差异（Ala-Gln组为-3.2±1.6 g，Conv组为-6.5±2.7 g）。Ala-Gln组术后血浆IL-6水平与累积氮平衡之间存在显著负相关，而Conv组未观察到这种相关性。
补充Gln二肽的TPN对术后血浆IL-8水平无影响。然而，补充Gln对病情较轻的患者术后降低全身IL-6的产生有有益作用，并且当给予Gln时，较低的血浆IL-6可能改善腹部手术患者的氮平衡。
