van der Hulst R R, von Meyenfeldt M F, Deutz N E, Stockbrügger R W, Soeters P B
Department of Surgery and Gastroenterology, University of Limburg, Maastricht, The Netherlands.
J Surg Res. 1996 Feb 15;61(1):30-4. doi: 10.1006/jsre.1996.0076.
The small intestine has been identified as an important site of metabolism of glutamine. The impairment of gut mucosa integrity during total parenteral nutrition (TPN) has been ascribed to a diminished supply of glutamine, due to the lack of glutamine in standard TPN. In addition, nutritional depletion diminishes glutamine availability in the intestine. The uptake of glutamine in the gut is dependent on the plasma glutamine concentration. This study was performed to observe changes in plasma and mucosa amino acid content during infusion of standard TPN and during infusion of TPN supplemented with glutamine. Twenty patients were randomly allocated to an experimental group (GTPN, TPN containing 0.23 g glutamine/kg.day) and a control group (CTPN, standard TPN). Patients received the iso-nitrogenous and isocaloric TPN during 10-14 days. After an overnight fast, before TPN was started, biopsies were taken from the duodenum. Amino acid concentrations were determined in the biopsies. Blood was taken for routine laboratory measurements and amino acid determination. This procedure was repeated on the last day of TPN infusion. Plasma glutamine in the GTPN group rose about 25% whereas plasma glutamine concentrations in the CTPN group remained unchanged. Mucosa glutamine rose with about 75% in the GTPN group whereas in the CTPN group no increase was observed. The rise of total plasma and mucosa amino acids was equal in both groups. The rise in plasma and mucosa glutamine was limited to nutritionally depleted patients. In conclusion, parenteral glutamine administration increases plasma and subsequently mucosa glutamine, specifically in depleted patients.
小肠已被确定为谷氨酰胺代谢的重要部位。全胃肠外营养（TPN）期间肠黏膜完整性受损被归因于谷氨酰胺供应减少，这是由于标准TPN中缺乏谷氨酰胺。此外，营养消耗会减少肠道中谷氨酰胺的可利用性。肠道对谷氨酰胺的摄取取决于血浆谷氨酰胺浓度。本研究旨在观察输注标准TPN期间以及输注添加谷氨酰胺的TPN期间血浆和黏膜氨基酸含量的变化。20名患者被随机分为实验组（GTPN，含0.23 g谷氨酰胺/千克·天的TPN）和对照组（CTPN，标准TPN）。患者接受等氮和等热量的TPN治疗10 - 14天。在禁食过夜后，TPN开始前，从十二指肠取活检组织。测定活检组织中的氨基酸浓度。采集血液进行常规实验室检测和氨基酸测定。在TPN输注的最后一天重复此操作。GTPN组血浆谷氨酰胺升高约25%，而CTPN组血浆谷氨酰胺浓度保持不变。GTPN组黏膜谷氨酰胺升高约75%，而CTPN组未观察到升高。两组血浆和黏膜总氨基酸的升高情况相同。血浆和黏膜谷氨酰胺的升高仅限于营养消耗的患者。总之，肠外给予谷氨酰胺可增加血浆以及随后的黏膜谷氨酰胺，特别是在消耗患者中。
