Déchelotte Pierre, Hasselmann Michel, Cynober Luc, Allaouchiche Bernard, Coëffier Moïse, Hecketsweiler Bernadette, Merle Véronique, Mazerolles Michel, Samba Désiré, Guillou Yves Marie, Petit Jean, Mansoor Odile, Colas Gabriel, Cohendy Robert, Barnoud Didier, Czernichow Pierre, Bleichner Gérard
Nutrition Unit, Rouen University Hospital (PD), Rouen, France.
Crit Care Med. 2006 Mar;34(3):598-604. doi: 10.1097/01.CCM.0000201004.30750.D1.
Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated.
Prospective, double-blind, controlled, randomized trial.
ICUs in 16 hospitals in France.
One-hundred fourteen ICU patients admitted for multiple trauma (38), complicated surgery (65), or pancreatitis (11).
Patients were randomized to receive isocaloric isonitrogenous TPN via a central venous catheter providing 37.5 kcal and 1.5 g amino acids.kg-1.day-1 supplemented with either L-alanyl-L-glutamine dipeptide (0.5 g.kg-1.day-1; Ala-Gln group, n=58) or L-alanine+L-proline (control group, n=56) over at least 5 days.
Complicated clinical outcome was defined a priori by the occurrence of infectious complications (according to the criteria of the Centers for Disease Control and Prevention), wound complication, or death. The two groups were compared by chi-square test on an intention-to-treat basis. The two groups did not differ at inclusion for type and severity of injury (mean simplified acute physiology score II, 30 vs. 30.5; mean injury severity score, 44.9 vs. 42.3). Similar volumes of TPN were administered in both groups. Ala-Gln-supplemented TPN was associated with a lower incidence of complicated outcome (41% vs. 61%; p<.05), which was mainly due to a reduced infection rate per patient (mean, 0.45 vs. 0.71; p<.05) and incidence of pneumonia (10 vs. 19; p<.05). Early death rate during treatment and 6-month survival were not different. Hyperglycemia was less frequent (20 vs. 30 patients; p<.05) and there were fewer insulin-requiring patients (14 vs. 22; p<.05) in the Ala-Gln group.
TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.
补充谷氨酰胺（Gln）的全胃肠外营养（TPN）可改善计划性手术后的临床结局，但Gln-TPN对危重症（重症监护病房；ICU）患者的益处仍存在争议。
前瞻性、双盲、对照、随机试验。
法国16家医院的ICU。
114例因多发伤（38例）、复杂手术（65例）或胰腺炎（11例）入住ICU的患者。
患者通过中心静脉导管随机接受等热量等氮量的TPN，提供37.5 kcal和1.5 g氨基酸·kg-1·天-1，至少5天内补充L-丙氨酰-L-谷氨酰胺二肽（0.5 g·kg-1·天-1；丙氨酰-谷氨酰胺组，n = 58）或L-丙氨酸+L-脯氨酸（对照组，n = 56）。
预先将复杂的临床结局定义为发生感染性并发症（根据疾病控制与预防中心的标准）、伤口并发症或死亡。两组按意向性分析进行卡方检验比较。两组在纳入时的损伤类型和严重程度无差异（平均简化急性生理学评分II，30对30.5；平均损伤严重程度评分，44.9对42.3）。两组给予的TPN量相似。补充丙氨酰-谷氨酰胺的TPN与复杂结局发生率较低相关（41%对61%；p<0.05），这主要是由于每位患者的感染率降低（平均，0.45对0.71；p<0.05）以及肺炎发生率降低（10对19；p<0.05）。治疗期间的早期死亡率和6个月生存率无差异。丙氨酰-谷氨酰胺组的高血糖症发生率较低（20例对30例患者；p<0.05），需要胰岛素治疗的患者较少（14例对22例；p<0.05）。
ICU患者补充丙氨酰-谷氨酰胺二肽的TPN与感染性并发症发生率降低和更好的代谢耐受性相关。
