谷氨酰胺对创伤后大鼠恢复的效果

本研究观察了谷氨酰胺对创伤大鼠恢复的影响，１７只Ｗｉｓｔａｒ大鼠随机分成Ｇｉｎ组（９只）和对照组（８只），大鼠行创伤手术后，分别饲喂含或不含１．２％Ｇｈ的合成饲料，饲料等氮，等热量。实验中观察了动物体重恢复、血浆蛋白变化，实验第１４ｄｋ处死动物，测定伤口皮肤抗张力强度和胶原蛋白含量，淋巴细胞转化率，小肠粘膜核酸及蛋白质量，用Ｓｔｕｄｅｎｔ’ｓ ｔ检验分析结果差异的显著性。     

谷氨酰胺肠外营养对创伤后多器官衰竭患者的营养作用

目的探讨补充谷氨酰胺(Gln)的肠外营养在严重创伤后多器官衰竭(MOF)患者治疗中的作用。方法采用随机对照方法,将60例MOF患者分为Gln组和对照组,每组30例。Gln组给予Gln1.5ml/kg联合常规治疗[热量104～125kJ/(kg·d),其中脂肪供热40%,氮供给量为0.2～0.25g/(kg·d)的完全胃肠外营养(TPN)支持];对照组仅给予常规治疗,连续7d。对照分析营养指标、免疫指标、并发症及临床结果。结果所有患者营养指标(血清白蛋白、前清蛋白、转铁蛋白)和免疫指标(IgG、IgA、IgM)明显减低,处于负氮平衡。第8天时,Gln组营养指标明显高于治疗前及对照组(P<0.05),负氮平衡得到纠正(P<0.05),而对照组仅血清白蛋白、转铁蛋白较治疗前增高(P<0.05),仍处于负氮平衡(P>0.05)。Gln组免疫指标明显高于治疗前及对照组(P<0.01),而对照组仅IgG高于治疗前(P<0.01)。对照组14例(46.7%)出现了血清胆红素、丙氨酸转氨酶和血糖的升高,而Gln组仅4例(13.3%)增高(P<0.05),至14d时对照组病死率为36.7%,而Gln组仅为10%,两者相比差异有显著性(P<0.05)。结论应用Gln的肠外营养能够明显纠正MOF患者的营养代谢障碍,纠正负氮平衡,增强免疫功能,降低并发症及病死率。     

谷氨酰胺对创伤后肠粘膜通透性的影响

在创伤的情况下,肠道通透性将发生改变,继而引起细菌移位和内毒素血症。谷氨酰胺可以通过降低肠粘膜通透性来减少细菌移位、减轻内毒素血症。     

谷氨酰胺对创伤大鼠细胞免疫功能的影响

目的：研究经口补充谷氨酰胺（Ｇｌｕｔａｍｉｎｅ，Ｇｌｎ）对创伤大鼠细胞免疫功能的影响。方法：采用闭合性创伤大鼠模型，通过补充或不补充谷氨酰胺，观察创伤后血浆、脾脏和肠系膜淋巴结细胞Ｇｌｎ含量，以及细胞免疫功能的动态变化。结果：创伤后补充Ｇｌｎ组（Ｇｌｎ组）血浆、脾脏和肠系膜淋巴结细胞Ｇｌｎ含量明显高于不补充Ｇｌｎ组（Ｎｏｎ－Ｇｌｎ组）；伤后大鼠脾脏和肠系膜淋巴结细胞的Ｔ淋巴细胞增殖反应下降，白介素－２（ＩＬ－２）生成减少，细胞膜ＩＬ－２受体（ＩＬ－２Ｒ）表达受抑，但Ｇｌｎ组动物的免疫抑制程度明显轻于Ｎｏｎ－Ｇｌｎ组。结论：经口补充Ｇｌｎ，能有效地提高创伤后血浆Ｇｌｎ水平，保持脾脏、淋巴结细胞及腹腔巨噬细胞内Ｇｌｎ正常含量，改善细胞免疫功能，减轻创伤后的免疫受抑程度。     

丙氨酰谷氨酰胺对创伤大鼠静脉营养效用的研究

目的　比较丙氨酰谷氨酰胺二肽 (Ala- Gln)和谷氨酰胺 (Gln)对创伤大鼠静脉营养支持的效果。方法　 36只 Wistar雄性大鼠 (2 0 0± 1 0 ) g,随机分为对照、Ala- Gln和 Gln组 ,行创伤和中心静脉插管手术后 ,分别输以不含 Gln、含 1 .8% Ala- Gln或 1 .2 % Gln的等氮、等能量结晶氨基酸注射液 ,喂以无氮饲料 ,实验期为 1 4天。测定氮平衡、血浆氨基酸和蛋白质含量、尾血淋巴细胞转化反应和小肠粘膜核酸、蛋白质含量等指标。结果　Ala- Gln和 Gln组动物术后 8天氮平衡、血浆 Gln的浓度、外周血淋巴细胞转化率和小肠粘膜 DNA、RNA、蛋白质含量均显著高于对照组(P<0 .0 5)。结论　 Ala- Gln和 Gln都有助于改善创伤后机体的代谢状况 ,增强免疫功能 ,促进小肠粘膜细胞增殖 ,以维持肠道的完整性 ,Ala- Gln与 Gln具有相同的营养支持效果。     

丙氨酰谷氨酰胺对实验创伤大鼠静脉营养效用的实验研究

目的 创伤引起机体分解代谢增强，并对谷氨酰胺(Gln)的需求量增加，补充外源性Gln十分必要。但是由于Gln在溶液中不稳定，加热产生有毒的焦谷氨酸和氨，使其在肠外营养中的应用受到限制，丙氨酰谷氨酰胺(Ala-Gin)性质稳定，在肠外营养中的应用日益受到重视。方法 采用创伤大鼠中心静脉输注模型，对Ala-Gln和Gln的肠外营养效用进行了比较。36只Wistar雄性大鼠(200±10g)，随机分为对照、Ala-Gin和Gln组，行创伤和中心静脉插管手术后，分别输以不含Gln、含1．8％Ala-Gln或1．2％Gln的复合结晶氨基酸注射液(1．0g·d^-1·kg^-1)，喂以无氮饲料，实验期为14天。每日称取食料摄入量，隔日称体重，第4、8天，收集24h尿，进行氮平衡分析，实验结束时，测定动物的血浆总蛋白、白蛋白、前白蛋白、纤维结合蛋白和血浆Gln含量，外周血T淋巴细胞转化反应及小肠粘膜核酸、蛋白质含量。结果各组动物之间的摄食量、体重、血浆总蛋白、白蛋白和前白蛋均差异无显性。创伤和中心静脉插管的刺激引起动物血浆纤维结合蛋白较术前升高，但Ala-Gln和Gln组动物恢复状况好于对照组(P<0．05)。Ala-Gln和Gln组动物的氮平衡、血浆Gln浓度、外周血淋巴细胞转化率及小肠粘膜DNA、RNA和蛋白质含量均显高于对照组(P<0．05)。结论Ala-Gln在体内被分解为丙氨酸和Gln，与Gln同样能增加血中Gln的浓度，降低骨胳肌蛋白质的分解，改善创伤后机体的营养及代谢状况，增强免疫功能，促进小肠粘膜细胞增殖，以维持肠道的完整性。Ala-Gln与Gln具有相同的营养支持效果。     

补充谷氨酰胺对运动小鼠谷氨酰胺代谢的影响

目的　探讨大强度慢性运动情况下 ,补充谷氨酰胺 (Gln)对血浆和骨骼肌 Gln水平、组织 Gln合成酶和谷氨酰胺酶活性变化的影响。方法　BAL/C小鼠负重 (2 %体重 )游泳 ,每天2 h,持续 8w。结果　与对照组比较 ,大强度游泳组动物血浆和肌肉中的 Gln浓度分别降低 74%(P<0 .0 1 )和 79%(P<0 .0 1 ) ,骨骼肌 Gln合成酶活性降低 3 3 .5 %(P<0 .0 1 ) ,淋巴细胞谷氨酰胺酶活性增加 3 1 5 %(P<0 .0 1 )。与游泳组比 ,游泳 +Gln补充组血浆和骨骼肌 Gln浓度分别提高了1 42 %(P<0 .0 1 )和 44.7%(P=0 .0 5 6 )、骨骼肌 Gln合成酶增加 1 8.0 %(P<0 .0 1 ) ,淋巴细胞谷氨酰胺酶降低了 2 5 .4%(P<0 .0 5 )。结论　大强度运动时 ,经口补充 Gln提高血浆 Gln浓度 ,可能与Gln被吸收入血有关 ;运动引起的 Gln合成减少不仅归因于底物的减少 ,还有合成酶活性降低的影响。     

谷氨酰胺对创伤感染大鼠抗氧化能力及死亡率的影响

目的　研究经口补充谷氨酰胺 (Gln)对创伤感染大鼠免疫组织抗氧化能力及死亡率的影响。方法　采用闭合性创伤大鼠模型及补充或不补充 Gln两种方法 ,于伤后第 7d静注活绿脓杆菌 ,观察注菌后 7d内动物的死亡率 ,并检测存活动物血浆 Gln浓度、以及血浆、脾脏和肠系膜淋巴结组织内还原型谷胱甘肽 (GSH)和丙二醛 (MDA)水平。结果　创伤感染后第 7d大鼠死亡率 Gln组明显低于 Non- Gln组。Gln组存活动物的血浆 Gln浓度明显高于 Non- Gln组 ;而血浆、脾脏和肠系膜淋巴结组织 GSH水平两组均有明显下降 ,但 Non- Gln组下降程度明显大于 Gln组 ;同时 ,两组 MDA含量均有明显增加 ,但 Non- Gln组增加程度明显大于 Gln组。结论　经口补充Gln能明显降低创伤感染大鼠免疫组织脂质过氧化水平 ,增强其抗氧化损伤的能力 ,提高创伤感染后的存活率。     

肠道补充谷氨酰胺对肠系膜淋巴结、脾脏谷氨酰胺酶活力的影响

本文采用小型香猪３０％ＴＢＳＡ烧伤模型，观察了烧伤后肠道补充谷氨酰胺对肠系膜淋巴结、脾脏组织谷氨酰胺酶活力的影响，动物随机分为补充谷氨酰胺组（ｎ＝７）和不补充谷氨酰胺组（ｎ＝７），谷氨酰胺组动物补充谷氨酰胺０．６４ｇ／（ｋｇ·ｄ），不补充谷氨酰胺组供...     

营养支持中补充谷氨酰胺的潜在作用

本支综述了谷氨酰胶、谷氨酰胺双肽及谷氨酰胺前体（鸟氨酰－α－酮戊酸和α－酮戊酸）在营养支持中的作用。结果表明，补充GLN或GLN前体的肠内或肠外营养能被很好耐受并且在许多病人群中证明了其有益作用。但机制仍不清楚，可能有多种相互有关的机制。如增加蛋白质合成和减少蛋白质分解反应而改善氮平衡；促进DNA和RNA的合成；改善膜屏障防御功能和维持组织抗氧化剂储存等。有必要对GLN作用的临床效能和分子基础作进一步的研究。     

谷氨酰胺对肿瘤病人术后营养状况及免疫功能的影响

目的 探讨谷氨酰胺对肿瘤病人术后营养状况及免疫功能的影响。方法 20例胃肠道肿瘤病人术后随机分为常规TPN组（对照组）10例和TPN＋Gln组（研究组）10例，治疗8天，观察血清前白蛋白、血清转铁蛋白、氮平衡变化。并检查其前后外周血IgG、IgM、IgA、C3、C4的变化。结果 （1）两组病人负氮平衡改善，研究组与对照组比较差异明显（P＜0．01）。两组病人血清蛋白均上升，研究组回升更明显，与对照组比较具有显差异（P＜0．01）。（2）研究组外周血IgG、IgM、IgA明显升高，与对照组比较差异显（P＜0．05）。研究组C3、C4明显升高与对照组比较差异显（P＜0．05）。结论 谷氨酰胺改善了肿瘤术后病人的营养状况，提高了免疫功能。     

Altered brain and muscle amino-acid levels due to remote injury during glutamine supplementation

Glutamine (GLN) has aroused considerable interest among clinicians and nutritionists after studies demonstrated conclusively profound GLN depletion during critical illness. Although the brain plays an important role in GLN metabolism, little is known concerning changes in cerebral handling of GLN following injury. We have evaluated in a rat trauma (bilateral femur fractures) model, the nutritional efficacy of GLN-rich diet and the remote injury-induced changes in amino-acid (AA) contents of brain and muscle tissues. Both control and traumatised rats were starved for 2 days and then pair-fed for 4 days, either a basic liquid diet (BioServ # F1259) or an isonitrogenous test diet which contained the same basic diet from which 10% nitrogen (N) was replaced by GLN-N. Protein efficiency ratio as well as plasma levels of anabolic growth hormone and insulin did not change due to GLN-enriched diet. Remote injury-induced changes in GLN and glutamic acid (GLU) during GLN-rich diet were minimal in brain tissues; whereas GLN levels were decreased in plasma and muscle, GLU levels were increased in plasma and decreased in muscle tissues. The AA levels of brain tissues, in general, were maintained within narrow limits during GLN supplementation in control and injured rats. An increased influx of tryptophan and increased synthesis of the neurotransmitter serotonin were suggested due to GLN-enriched diet.     

Clinical use of glutamine supplementation

Endogenous production of glutamine may become insufficient during critical illness. The shortage of glutamine is reflected as a decrease in plasma concentration, which is a prognostic factor for poor outcome in sepsis. Because glutamine is a precursor for nucleotide synthesis, rapidly dividing cells are most likely to suffer from a shortage. Therefore, exogenous glutamine supplementation is necessary. In particular, when i.v. nutrition is given, extra glutamine supplementation becomes critical, because most present formulations for i.v. use do not contain any glutamine for technical reasons. The major part of endogenously produced glutamine comes from skeletal muscle. For patients staying a long time in the intensive care unit (ICU), the muscle mass decreases rapidly, which leaves a tissue of diminishing size to maintain the export of glutamine. The metabolic and nutritional adaptation in long-staying ICU patients is poorly studied and is one of the fields that needs more scientific evidence for clinical recommendations. To date, there is evidence to support the clinical use of glutamine supplementation in critically ill patients, in hematology patients, and in oncology patients. Strong evidence is presently available for i.v. glutamine supplementation to critically ill patients on parenteral nutrition. This must be regarded as the standard of care. For patients on enteral nutrition, more evidence is needed. To guide administration of glutamine, there are good arguments to use measurement of plasma glutamine concentration for guidance. This will give an indication for treatment as well as proper dosing. Most patients will have a normalized plasma glutamine concentration by adding 20-25 g/24 h. Furthermore, there are no reported adverse or negative effects attributable to glutamine supplementation.     

谷氨酰胺双肽强化的静脉营养促进烧伤创面愈合的机制

目的探讨静脉补充谷氨酰胺双肽促进烧伤患者术后创面愈合的可能机制。方法30例烧伤总面积10％～30％,Ⅲ度烧伤面积≥1％的患者随机进入对照组和研究组,每组15例。两组在手术后接受静脉营养治疗7d,研究组接受静脉谷氨酰胺双肽0．5g·kg^-1·d^-1。分别检测术前1天和术后第7天患者的血浆游离羟脯氨酸浓度,统计术后创面愈合时间。结果对照组和研究组的术前血浆游离羟脯氨酸浓度分别为（2．24±0．84）和（2．32±0．92）μg／ml,均高于正常值的（1．27±0．44）μg／ml,但是差异无统计学意义。术后第7天对照组和研究组的血浆游离羟脯氨酸浓度分别为（3．04±1．01）和（4．31±1．05）μg／Ⅲ,均高于手术前水平,研究组的血浆游离羟脯氨酸浓度显著高于对照组（P=0．002）。研究组的创面愈合时间为（29.7±5．3）d,短于对照组的（33．3±7．5）d,但差异无统计学意义（P=0．14）。结论静脉补充谷氨酰胺双肽有助于提高烧伤患者术后血浆游离羟脯氨酸浓度,可能对创面愈合有促进作用。     

Effect of oral glutamine supplementation on human neutrophil lipopolysaccharide-stimulated degranulation following prolonged exercise

Recent studies have shown that neutrophils can utilize glutamine and that glutamine supplementation can improve neutrophil function in postoperative and burn patients. The present study investigated the influence of oral glutamine supplementation on stimulated neutrophil degranulation and oxidative burst activity following prolonged exercise. Subjects, 7 well-trained men, reported to the laboratory following an overnight fast and cycled for 2 hrs at 60% VO2max on two occasions a week apart. They were randomly assigned to either a glutamine or placebo treatment. For both trials, subjects consumed a sugar-free lemon drink at 15-min intervals until 90 minutes, then a lemon flavored glutamine drink (GLN) or sugar-free lemon drink (PLA) was consumed at 15-min intervals for the remaining exercise and the 2-hr recovery period. Venous blood samples were taken pre-, during, and postexercise. Glutamine supplementation had no effect on the magnitude of postexercise leukocytosis, the plasma elastase concentration following exercise (which increased in both trials), or the plasma elastase release in response to bacterial stimulation (which fell in both trials). Neutrophil function assessed by oxidative burst activity of isolated cells did not change following exercise in either trial. These findings therefore suggest that the fall in plasma glutamine concentration does not account for the decrease in neutrophil function (degranulation response) following prolonged exercise.     

谷氨酰胺对新生儿临床结局的影响

目的 评价肠内、肠外补充谷氨酰胺对新生儿临床结局的影响.方法 采用平行、随机、双盲、对照试验,将100例新牛儿随机分为5组,分别为对照组(常规肠外营养组)、肠外谷氨酰胺1组[肠外营养1组,在常规肠外营养中静脉补充谷氨酰胺0.3 g/(kg·d),其中谷氨酰胺取代了处方中相应氨基酸的量]、肠内谷氨酰胺Ⅰ组[肠内营养1组,口服添加谷氨酰胺0.3 g/(kg·d),谷氨酰胺取代了常规肠外营养中相应氨基酸的量]、肠外谷氨酰胺2组[肠外营养2组,在常规肠外营养中静脉补充谷氨酰胺0.3 g/(kg·d)]、肠内谷氨酰胺2组[肠内营养2组,口服添加谷氨酰胺0.3 g/(kg·d)],每组20例,对照组按照常规给予肠外营养支持,氨基酸的剂量按照中国新生儿营养支持临床应用指南给予[从1.0～2.0 g/(kg·d)开始,增至3.5 g/(kg·d)].首要终点指标为达到全肠内喂养日龄[标准配方摄入量≥120ml/(kg·d)]、胃潴留次数、完全脱离肠外营养时间和死亡率.次要终点指标为体重变化和头围变化、肝功能、肾功能、呼吸机应用天数、住院天数.结果 5组患儿达到全肠内喂养日龄、胃潴留次数及脱离肠外营养时间差异均无显著性.患儿肝肾功能水平及体重增长、头围增长、抗生素应用天数、住院天数差异均无显著性(P＞0.05).肠外谷氨酰胺1组和2组较对照组呼吸机应用天数显著减少(P＜0.05).死亡率通过意向性分析显示,与对照组比较,肠外谷氨酰胺1组RR为1.053,95%CI为0.952～1.164;肠内谷氨酰胺1组RR为1.333,95%CI为1.035～1.717;肠外谷氨酰胺2组RR为1.053,95%CI为0.952～1.164;肠内谷氨酰胺2组RR为1.25,95%CI为1.004～1.556.结论 补充谷氨酰胺未能缩短达到全肠内喂养天数、减少胃潴留次数、缩短全肠外营养应用时间;肠外补充谷氨酰胺可以减少新生儿呼吸机应用大数.新生儿肠外补充谷氨酰胺对患儿住院期间的死亡率无明显影响.     

Effects of oral supplementation of glutamine on small intestinal mucosal mass following resection.

Following massive small bowel resection, the remaining small bowel increases in mucosal weight, protein, deoxyribonucleic acid (DNA) content and absorptive function. Enteral nutrients are known to be important in stimulating this response. Recently, glutamine has been described as an essential fuel for the small intestinal mucosa and is thought to be trophic to the small bowel. We investigated if glutamine, when added to the diet in large quantities, might stimulate mucosal adaptation beyond that which normally occurs following physiologic feedings. Male Sprague-Dawley rats were placed on powdered rat chow supplemented with either 5% glutamine, 5% glycine or 5% glucose. After 4 days rats underwent 70% jejunoileal resection. Fourteen days after resection, protein, DNA and sucrase activity in the duodenum of the glutaminefed animals were all significantly lower than results from both the glycine and glucose groups. Duodenal mucosal weight was lower in the glutamine group than in the glycine group. In the ileum, DNA content was significantly lower for the glutamine group than the glycine group. These results suggest that high concentrations of glutamine in the diet can have negative effects on intestinal adaptation.