Frankel W L, Zhang W, Afonso J, Klurfeld D M, Don S H, Laitin E, Deaton D, Furth E E, Pietra G G, Naji A
Harrison Department of Surgical Research, Hospital of the University of Pennsylvania, Wistar Institute, Philadelphia.
JPEN J Parenter Enteral Nutr. 1993 Jan-Feb;17(1):47-55. doi: 10.1177/014860719301700147.
Total parenteral nutrition is required by all patients in need of small bowel transplantation. Untoward side effects of total parenteral nutrition include atrophy and hypofunction of the small intestine. Glutamine, the preferred fuel for the enterocyte, is presumably present in insufficient amounts in diets given to patients with intestinal dysfunction. In a rat model of total parenteral nutrition and small bowel transplantation, this study investigated the following: (1) whether glutamine improves graft structure and function, (2) the optimal route of glutamine delivery (intravenous vs direct infusion into the graft), and (3) the effect of glutamine on ultrastructure of the graft enterocyte. Lewis rats underwent small bowel transplantation as a Thiry-Vella graft and received total parenteral nutrition for 14 days while assigned to one of four infusion groups: 2% intravenous glutamine; 2% intravenous isonitrogenous mixture, nonessential amino acids (control); 2% glutamine into the graft; or 2% nonessential amino acids into the graft (control). Graft mucosal villous height, villous surface area, crypt depth, weight, protein, deoxyribonucleic acid content, glucose absorption, and enterocyte ultrastructure were then evaluated. Infusion of glutamine directly into the graft significantly increased mucosal villous height (p = .045), surface area (p = .029), and glucose absorption (p = .004) when compared with controls. Intravenous glutamine infusion significantly increased mucosal villous height (p = .002), surface area (p = .001), weight (p = .005), and glucose absorption (p = .04) when compared with controls. Most enterotrophic and functional benefits of glutamine were not significantly different between intravenous infusions and direct administration into the graft.(ABSTRACT TRUNCATED AT 250 WORDS)
所有需要进行小肠移植的患者都需要全胃肠外营养。全胃肠外营养的不良副作用包括小肠萎缩和功能减退。谷氨酰胺是肠细胞的首选燃料，肠道功能障碍患者的饮食中谷氨酰胺含量可能不足。在全胃肠外营养和小肠移植的大鼠模型中，本研究调查了以下内容：（1）谷氨酰胺是否能改善移植物的结构和功能；（2）谷氨酰胺的最佳给药途径（静脉注射与直接注入移植物）；（3）谷氨酰胺对移植物肠细胞超微结构的影响。将Lewis大鼠作为Thiry-Vella移植物进行小肠移植，并接受14天的全胃肠外营养，同时被分配到四个输注组之一：2%静脉注射谷氨酰胺；2%静脉注射等氮混合物、非必需氨基酸（对照组）；2%谷氨酰胺注入移植物；或2%非必需氨基酸注入移植物（对照组）。然后评估移植物黏膜绒毛高度、绒毛表面积、隐窝深度、重量、蛋白质、脱氧核糖核酸含量、葡萄糖吸收和肠细胞超微结构。与对照组相比，直接向移植物中注入谷氨酰胺可显著增加黏膜绒毛高度（p = 0.045）、表面积（p = 0.029）和葡萄糖吸收（p = 0.004）。与对照组相比，静脉输注谷氨酰胺可显著增加黏膜绒毛高度（p = 0.002）、表面积（p = 0.001）、重量（p = 0.005）和葡萄糖吸收（p = 0.04）。静脉输注和直接注入移植物之间，谷氨酰胺的大多数肠营养和功能益处没有显著差异。（摘要截选至250字）
