van den Berg Anemone, Fetter Willem P F, Westerbeek Elisabeth A M, van der Vegt Ina M, van der Molen Hilda R A, van Elburg Ruurd M
Department of Pediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands.
JPEN J Parenter Enteral Nutr. 2006 Sep-Oct;30(5):408-14. doi: 10.1177/0148607106030005408.
Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion. Glutamine depletion has negative effects on intestinal integrity. The lower infection rate in VLBW infants receiving glutamine-enriched enteral nutrition may originate from improved intestinal integrity, as reflected by decreased intestinal permeability. The aim of our study was to investigate whether glutamine-enriched enteral nutrition in VLBW infants enhances the normal decrease in intestinal permeability, as measured by the sugar absorption test (SAT).
In a double-blind, randomized, placebo-controlled trial, VLBW infants (gestational age <32 weeks or birth weight <1,500 g) received enteral glutamine supplementation (0.3 g/kg/d) or an isonitrogenous placebo supplementation (alanine) between days 3 and 30 of life. Intestinal permeability, determined from the urinary lactulose/mannitol (L/M) ratio after an oral dose of lactulose and mannitol, was assessed at 4 time points: before the start of the study, and at days 7, 14, and 30 of life.
At least 2 SATs were performed in 45/52 (86%) and 45/50 (90%) infants in the glutamine-supplemented and control groups, respectively. Baseline patient and nutrition characteristics were not different between the groups. There was no effect of glutamine-enriched enteral nutrition on the decrease of the L/M ratio between the start and end of the study (p = .78). In both treatment groups, median urinary lactulose concentrations decreased (p < .001), whereas median urinary mannitol concentrations increased (p = .003).
Glutamine-enriched enteral nutrition does not enhance the postnatal decrease in intestinal permeability in VLBW infants. Any beneficial effect of glutamine may involve other aspects of intestinal integrity; for example, modulation of the intestinal inflammatory response.
极低出生体重（VLBW）婴儿易发生谷氨酰胺耗竭。谷氨酰胺耗竭对肠道完整性有负面影响。接受富含谷氨酰胺肠内营养的VLBW婴儿感染率较低，这可能源于肠道完整性的改善，表现为肠道通透性降低。我们研究的目的是调查富含谷氨酰胺的肠内营养是否能增强VLBW婴儿肠道通透性的正常下降，这通过糖吸收试验（SAT）来衡量。
在一项双盲、随机、安慰剂对照试验中，VLBW婴儿（胎龄<32周或出生体重<1500g）在出生后第3天至第30天接受肠内补充谷氨酰胺（0.3g/kg/d）或等氮安慰剂补充剂（丙氨酸）。通过口服乳果糖和甘露醇后测定尿乳果糖/甘露醇（L/M）比值来确定肠道通透性，在4个时间点进行评估：研究开始前，以及出生后第7天、第14天和第30天。
谷氨酰胺补充组和对照组分别有45/52（86%）和45/50（90%）的婴儿至少进行了2次SAT。两组间基线患者和营养特征无差异。富含谷氨酰胺的肠内营养对研究开始和结束之间L/M比值的下降没有影响（p = 0.78）。在两个治疗组中，尿乳果糖中位数浓度均下降（p < 0.001），而尿甘露醇中位数浓度升高（p = 0.003）。
富含谷氨酰胺的肠内营养并不能增强VLBW婴儿出生后肠道通透性的下降。谷氨酰胺的任何有益作用可能涉及肠道完整性的其他方面；例如，调节肠道炎症反应。
