谷氨酰胺和重组人生长激素对门静脉高压症患者术后肠黏膜屏障功能的影响

目的研究单独或联合应用谷氨酰胺（Gln）和重组人生长激素（rhGH）对门静脉高压症患者术后肠黏膜屏障功能的影响。方法将29例肝硬化门静脉高压症接受手术治疗的患者随机分为4组：Gln组（n=6）、rhGH组（n=8）、Gln＋rhGH组（n=7）和对照组（n=8）。术后3天开始进行等氮、等热量的全胃肠外营养（TPN）支持，持续7天。对患者手术前、后的尿乳果糖／甘露醇（L／M）、十二指肠降段黏膜绒毛高度及陷窝深度进行测定。结果Gln＋rhGH组L／M升高的幅度显著小于对照组（P〈0．05），Gln和rhGH组与对照组比较差异无显著性。Gln＋rhGH组肠黏膜绒毛高度和陷窝深度均大于对照组（P〈0．05），Gln和rhGH组与对照组比较差异无显著性（P〉0．05）。Gln＋rhGH组术后绒毛高度及陷窝深度均显著大于术前（P〈0．05）；对照组术后绒毛高度小于术前（P〈0．05），陷窝深度差异无显著性（P〉0．05）；Gln和rhGH组手术前、后绒毛高度及陷窝深度差异无显著性（P〉0．05）。结论联合应用Gln和rhGH能降低门静脉高压症患者术后肠壁通透性并维护肠黏膜形态学完整性，单独应用Gln或rhGH无此作用。

Effects of Glutamine and Recombinant Human Growth Hormone on Intestinal Mucosal Barrier in Postoperative Portal Hypertension Patients

Objective To investigate the morphologic and functional changes of small intestinal mucosa in postoperative portal hypertension patients with single or combined administration of glutamine(Gln)and recombinant human growth hormone(rhGH).Methods Twenty-nine portal hypertension patients underwent surgical treatment were prospectively randomized to four groups as follows:Gln group(n=6),rhGH group(n=8),Gln+rhGH group(n=7)and control group(n=8).A standard solution for total parenteral nutrition(TPN)was given to every patient since postoperative day 3 and lasted for 7 days.The concentration ratio of urinary lactulose and mannitol(L/M),villus height,and crypt depth of small intestinal mucosa were then compared.Results After 7 days of TPN postoperatively,the concentration ratios of L/M in Gln + rhGH group were significantly less than those in control group(P<0.05).There were not significant increases between control group and Gln group or rhGH group.Villus height and crypt depth significantly increased after TPN in the Gln+rhGH group(P<0.05).The villus height in control group decreased(P<0.05),whereas the crypt depth had no significant difference(P>0.05).In addition,the villus height and crypt depth of Gln group and rhGH group had no significant difference after TPN(P>0.05).Conclusion Gln combined with rhGH can reduce the gut permeability and ameliorate intestinal mucosal morphology in postoperative portal hypertension patients;however,neither Gln nor rhGH has such effect when used alone.