精氨酸等强化肠内营养对颅脑外伤患者营养及免疫功能的影响

目的 探讨精氨酸、谷氨酰胺强化肠内营养对重度颅脑外伤病人的营养支持效果及对免疫功能的影响。方法 47例重度颅脑外伤病人随机分为氨基酸强化组和常规对照组，术后48h内开始管饲肠内营养，精氨酸、谷氨酰胺强化组和对照组等氮等热量营养支持，观测肠内营养前、第7d和第10d各患者的营养指标和免疫指标。结果精氨酸、谷氨酰胺强化组和对照组病人总蛋白、白蛋白、三角肌皮褶厚度、身高体重指数等差异无显著性，观察组内脏蛋白浓度高于对照组；观察组病人IgA、IgG、IgM、C3、C4、CD3、CD4、CD4/CD8上升较对照组明显（P〈0.05）。结论 精氨酸、谷氨酰胺强化肠内营养剂的营养支持效果良好，可增强机体免疫功能，促进机体康复。     

早期肠内营养联合丙氨酰谷氨酰胺在胃癌术后的临床应用

目的观察早期肠内营养联合丙氨酰谷氨酰胺对胃癌患者术后恢复的影响。方法对104例胃癌根治性切除手术患者,随机分为2组,每组52例。对照组常规给予术后早期肠内营养,治疗组术后早期肠内营养同时联合静脉注射丙氨酰谷氨酰胺;观察两组患者肛门排气,排便时间,住院时间,临床营养费用以及并发症发生情况,术后第7天、14天监测患者血红蛋白,血浆白蛋白等。结果治疗组术后第7天、14天血红蛋白、血浆白蛋白较对照组高,临床营养费用较对照组低,差异有统计学意义;肛门排气、排便时间较对照组短,并发症较少,但差异无统计学意义。结论早期肠内营养联合丙氨酰谷氨酰胺能明显改善胃癌患者术后营养状况,减少临床营养费用,在胃癌患者手术治疗中值得推广使用。     

营养支持及手术应激对IL-10、HLA-DR表达的影响

目的 :测定肠内营养 (EN)、肠外营养 (PN)支持及手术 (OP)应激病人外周血单核细胞人白细胞抗原裂解反应 (HLA DR)的表达以及外周血白细胞介素 1 0 (IL 1 0 )、C反应蛋白 (CRP)水平 ,从而了解不同营养支持条件以及手术应激对外周血单核细胞HLA DR、IL 1 0以及血浆CRP的影响。　方法 :检测 1 0例对照病人、2 1例PN病人或 1 8例EN病人以及 8例手术病人外周血单核细胞HLA DR、IL 1 0以及CRP水平。　结果 :单核细胞HLA DR抗原表达各组差异显著。与对照组 (96 .35± 4 .2 82 ) %比较 ,OP组 (6 0 .2 3± 1 0 .4 1 9) %下降最明显 (P <0 .0 1 ) ,PN组 (78.72±1 3.2 1 ) %次之 (P <0 .0 1 ) ,EN组 (93.1 1± 7.6 4 1 ) %无显著差异 (P >0 .0 5 )。CRP水平从低到高依次为对照组 (4 .5 73± 0 .5 89 6 )mg/L ,EN组 (7.1 4 5± 0 .85 4 6 )mg/L ,PN组 (7.393± 0 .85 4 6 )mg/L ,OP组 (7.4 80± 0 .9389)。IL 1 0以OP组升高明显 (P <0 .0 1 ) ,其余各组间无显著差异。　结论 :EN对免疫功能影响最小 ,是最佳的营养支持途径     

含不同剂量谷氨酰胺肠内营养在老年危重患者营养支持中的应用

目的通过不同剂量谷氨酰胺肠内营养对老年危重患者的营养支持,观察老年危重患者营养状态、胃肠道功能改善情况。方法将90例老年危重患者完全随机化法分成3组：不含谷氨酰胺的营养支持对照组（A组）,低剂量谷氨酰胺[0．3g/（kg·d）]肠内营养组（B组）,高剂量谷氨酰胺[0．6g／（kg·d）]肠内营养组（C组）。于营养支持的第1、7、14天清晨采集空腹静脉血,测定血浆二胺氧化酶、谷氨酰胺,观察血清谷氨酰胺含量变化对肠黏膜屏障功能的影响,并测定血红蛋白、血清白蛋白、转铁蛋白、前白蛋白等营养指标及氮平衡情况,同时观察患者的腹胀、腹泻、胃潴留等胃肠道功能情况。结果营养支持后第7、14天B组和C组血浆谷氨酰胺水平分别为（1886．8±420．5）、（2228．6±440．2）g/L和（1889．6±436．1）、（2174．3±440．8）g/L,较A组（1612．0±493．5）和（1869．7±559．8）μg/L显著升高（P=0．027,P=0．008）;二胺氧化酶在B组和C组分别为（2310±1271）、（1602．5±1137．9）U／L和（2076．3±567）、（1586．3±530．9）U／L,较A组的（3250±923）和（2476±862）U／L显著降低（P=0．000,P=0．000）。营养支持后第7天转铁蛋白、前白蛋白明显改善（P=0．023,P=0．047）,第14天血红蛋白明显改善（P=0．003）。B、C组成功实施EN人数和达到EN目标人数分别是4和25例、3和27例,较A组12和13例多（P=0．008,P=0．000）,胃肠道的并发症发生率较A组少。结论含谷氨酰胺的肠内营养能早期改善危重患者的肠黏膜屏障功能和营养状态,减少胃肠功能并发症。通过肠道给予谷氨酰胺,有利于成功实施肠内营养,并实现全肠内营养。     

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.     

谷氨酰胺联合肠内营养在重症急性胰腺炎患者中的应用效果

目的观察谷氨酰胺联合肠内营养在重症急性胰腺炎患者中的应用效果。方法选择2014年5月—2016年4月收治的重症急性胰腺炎患者120例,随机分为肠外营养组、肠内营养组及肠内营养联合组各40例。肠外营养组接受肠外营养,肠内营养组接受肠内营养,肠内营养联合组在肠内营养组基础上加入谷氨酰胺0.4 g/kg。比较三组有效率、病死率、感染率、手术率及住院时间;治疗前及治疗第7、14天急性生理与慢性健康Ⅱ评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ评分);治疗前及治疗第14天血清超敏C反应蛋白、肿瘤坏死因子α(tumor necrosis factor,TNF-α)、白细胞介素1β(Hematopoietin 1β,IL-1β)水平。计量资料比较采用单因素方差分析、计数资料比较采用χ~2检验,P0.05为差异有统计学意义。结果肠内营养联合组有效率、病死率、感染率、手术率及住院时间[92.5%、7.5%、22.5%、20.0%、(19.24±4.78)d]与肠外营养组[60.0%、40.0%、72.5%、67.5%、(30.84±4.52)d]、肠内营养组[77.5%、22.5%、40.0%、32.5%、(25.41±5.04)d]比较差异有统计学意义(均P0.05)。治疗第14天肠内营养联合组APACHEⅡ评分[(4.97±1.10)分]均低于肠外营养组[(7.51±2.24)分]、肠内营养组[(6.25±2.09)分](均P0.05)。治疗第14天肠内营养联合组超敏C反应蛋白、TNF-α、IL-1β[(0.71±0.34)mg/l、(7.13±1.46)、(0.10±0.02)pg/l]均低于肠外营养组[(1.64±0.59)mg/l、(14.03±2.08)、(0.20±0.04)pg/l]、肠内营养组[(1.20±0.45)mg/l、(11.08±2.15)、(0.16±0.05)pg/l](均P0.05)。结论谷氨酰胺联合肠内营养治疗重症急性胰腺炎效果好,病死率、感染率、手术率低,住院时间短,有效缓解患者临床症状体征及炎症反应。     

肠外肠内联合营养对老年重型颅脑外伤病人预后的影响

目的:探讨联合应用肠外、肠内营养对老年重型颅脑外伤病人预后的影响.方法:采用前瞻性对照的方法,对84例老年重型颅脑外伤病人早期营养支持的方法与作用进行研究.试验组早期开始给予肠外和肠内序贯营养;对照组按传统方法伤后6～7 d给予鼻饲流质.结果:试验组的氮平衡等营养指标均明显优于对照组(P＜0.05,P＜0.01);第14和第28天的GCS计分高于对照组(P＜0.05);病死率、肺部感染率显著低于对照组(P＜0.05).结论:肠外与肠内联合营养支持治疗,有利于改善老年重型颅脑外伤病人的预后.     

丙氨酰-谷氨酰胺双肽对术后肠道通透性和免疫功能的影响

目的:通过静脉补给丙氨酰-谷氨酰胺(Aln-Gln)双肽,观察对腹部手术后病人早期肠道通透性和免疫功能的影响.方法:20例腹部手术病人以前瞻、随机对照的方法分为研究组和对照组,每组各10例.从术后第1天开始,研究组病人每天静脉补给Aln-Gln双肽0.5 g/kg,共4 d;对照组病人用同等容量等渗盐水作为安慰剂.于手术前、后分别检测血浆Gln浓度和反映肠道通透性和免疫功能的有关实验指标:尿乳果糖/甘露醇(L/M)比值、血浆二胺氧化酶(DAO)、外周血总淋巴细胞计数(TLC)和人类白细胞抗原(HLA)-DR.结果:术后第5天,对照组病人血浆Gln浓度较术前显著下降,研究组较术前显著升高,且研究组明显高于对照组(P<0.05).术后第5天对照组血浆DAO、尿L/M比值均较术前显著升高;研究组均较术前显著降低,且研究组显著低于对照组(P<0.05).研究组病人术后第5天,TLC和HLA-DR表达均显著高于对照组.结论:术后静脉补充Aln-Gln能维持和提高血浆Gln浓度,维护肠屏障功能,改善免疫功能,有利于病人术后的快速康复.     

合生元联合谷氨酰胺对重症急性胰腺炎病人行早期肠内营养耐受性及营养状况的影响

目的：探讨合生元制剂联合谷氨酰胺对重症急性胰腺炎(SAP)病人行早期肠内营养(EEN)肠道耐受性及营养状况的影响。方法：前瞻性选取2020年1月至2021年6月,联勤保障部队第九〇〇医院普通外科收治的78例SAP病人为研究对象,随机分为对照组(n=39)与实验组(n=39)。入院24～48 h内置入鼻空肠管进行EEN治疗。对照组给予含谷氨酰胺的肠内营养混悬液,实验组在前者基础上给予合生元制剂（双歧杆菌三联活菌+蔗果低聚糖）。比较两组病人干预后的每日胃排空情况（胃残余量）,干预7 d后肠内营养喂养不耐受症状、营养指标[血清运铁蛋白(TF)、白蛋白(ALB)、前白蛋白(PA)]。结果：干预后,实验组每日胃排空情况明显优于对照组,差异有统计学意义(P <0.05)。干预7 d后,实验组腹胀、腹痛、腹泻发生率显著低于对照组,差异有统计学意义(P <0.05),而恶心、呕吐发生率与对照组比较无统计学意义(P> 0.05)。两组营养状况指标较干预前均有明显提升,且实验组干预后明显高于对照组,差异有统计学意义(P <0.05)。结论：给予合生元制剂联合谷氨酰胺的肠内营养混悬液...     

早期肠内营养加用谷氨酰胺对重症急性胰腺炎患者营养状态的影响研究

目的：观察早期肠内营养加用谷氨酰胺对重症急性胰腺炎患者营养状态的影响。方法：将2009年1月-2012年12月本科收治的60例患者随机分为对照组（常现肠内营养）和观察组（谷氨酰胺强化）。检测患者第1天、治疗后第7天、第14天的白蛋白（ALB）、转铁蛋白（TF）指标和重症监护时间、出院时间。结果：两组治疗后ALB和TF显著升高,比较差异均有统计学意义（P〈0.05）;观察组的ALB和TF在治疗后第7天、第14天均显著高于对照组,差异均有统计学意义（P〈0.05）。对照组的重症监护时间和出院时间分别为（11.57±5.25）d、（21.34±10.27）d,观察组的重症监护时间和出院时间分别为（6.17±4.53）d、（13.41±8.74）d,观察组显著少于对照组,比较差异有统计学意义（P〈0.05）。结论：早期肠内营养与谷氨酰胺联用可明显改善重症急性胰腺炎患者的营养状况与生活质量。     

Glutamine-enriched enteral nutrition increases HLA-DR expression on monocytes of trauma patients

The aim of this study was to investigate the effect of glutamine-(Gln)-enriched enteral nutrition (EN) on human leukocyte antigen (HLA)-DR and FcgammaR1/CD64 expression on monocytes and plasma glutamine concentrations in multi-trauma patients. HLA-DR expression on monocytes is crucial in the presentation of foreign antigen to the immune system and is severely reduced in trauma patients. In vitro monocyte HLA-DR and FcgammaRI/CD64 expression is dependent on glutamine availability. To study the effect of glutamine supplemented enteral nutrition on HLA-DR and FcgammaRI/CD64 expression on CD14(+) monocytes, 55 multi-trauma patients were studied in a randomized, double-blinded, controlled trial. Trauma patients received either a Gln-enriched EN (glutamine group, n = 28) or an isocaloric, isonitrogenous control EN (control group, n = 27) and were compared with a group of age-matched healthy volunteers (healthy volunteers, n = 53). On d 1, 5, 9 and 14 after trauma, expressions of HLA-DR and FcgammaRI/CD64 were determined on CD14(+) monocytes using FACS analysis. Plasma glutamine levels were measured using HPLC. Plasma glutamine was lower in both trauma patient groups compared with healthy volunteers and from d 3 to d 5; glutamine was higher in the glutamine group than in the control group. On d 1, HLA-DR expression was much lower in both trauma patient groups than in healthy volunteers. HLA-DR expression was greater on d 5, 9 and 14 in the glutamine group than in the control group. FcgammaRI/CD64 expression on monocytes of trauma patients was not different than the expression of healthy volunteers. This study showed that glutamine-enriched enteral nutrition was associated with a higher HLA-DR expression on CD14(+) monocytes of trauma patients. No difference in monocyte FcgammaRI/CD64 expression was detected between patients that received the two enteral diets and between trauma patients and the healthy volunteers. Increased HLA-DR expression may improve cellular immune function and may be involved in the beneficial effect of glutamine on the occurrence of infections in trauma patients.     

早期肠内营养对重症急性胰腺炎患者临床预后的随机对照研究

[目的]了解早期肠内营养对重症急性胰腺炎患者预后的影响。[方法]采用随机对照试验设计。纳入符合重症急性胰腺炎诊断标准的患者40例。分为研究组和对照组。研究组由鼻空肠营养管给以氨基酸型肠内营养,对照组经锁骨下中心静脉置管输注输入肠外营养。两组均达到非蛋白热卡(20±2)kcal/kgd-1,氮0.2g/kgd-1(氨基酸1.5g/kg)的喂养目标。营养支持在患者入组后12h内开始。[结果]研究组20例患者入组,19例完成研究;对照组20例,均完成研究。两组患者之间的住院期间死亡率比较,未发现差异有统计学意义,但在完成研究的患者间的分析,发现研究组死亡率有下降趋势。患者的胰腺感染发生率和手术率,研究组显著低于对照组。研究组的住院时间[(24.1±5.3)dvs.(34.5±9.3)d,t=-2.615,P﹤0.0001)],住ICU时间[(14.6±8.7)dvs.(25.7±11.9)d,t=-4.197,P﹤0.01]显著少于对照组。[结论]早期肠内营养可显著改善重症急性胰腺炎患者的临床结局。     

营养支持对重型颅脑损伤病人营养指标和肺部感染的影响

目的:探讨肠内营养(EN)与肠外营养(PN)支持对重型颅脑损伤病人营养指标和肺部感染的影响。方法:将62例重型颅脑损伤病人分为PN组(n=30)和EN组(n=32)。比较两组病人在营养支持后第1和第2周的营养指标及肺部感染的发生率。结果:EN组病人的血清清蛋白和前清蛋白较PN组有明显改善,而PN组病人的谷丙转氨酶较EN组有明显升高。EN组病人肺部感染发生率明显低于PN组。结论:EN支持可改善重型颅脑损伤病人的营养指标,减少肺部感染的发生率,有利于病人康复。     

颅脑外伤患者肠内营养并发症分析及预防

目的探讨颅脑外伤患者肠内营养（EN）并发症的发生原因和防治措施。方法回顾性分析我院2005年1月至2008年12月103例接受EN的颅脑外伤患者的临床资料。结果103例接受EN的颅脑外伤患者中发生EN并发症者38例（66％）,无因EN并发症发生死亡。结论EN并发症在颅脑外伤患者营养支持疗法中常会发生,以胃肠道、代谢性并发症多见,其发生与疾病的严重程度、营养液的输注速度和用量、患者的代谢状况等因素密切相关。     

贲门癌术后肠道内和肠道外营养支持的观察

目的　观察不同途径的营养支持对经腹贲门癌术后病人的疗效。方法　 1 1 5例贲门癌患者分成肠外营养 (PN组 ) ,肠内营养 (EN组 )以及对照三组。 PN组 :给以全肠外静脉高营养液 (TPN) ,每日用量 :2 0 %的脂肪乳剂 2 50 ml、复方氨基酸溶液 1 0 0 0 ml,2 0 %的葡萄糖溶液 1 0 0 0ml,术后由周围静脉连续输注 8～ 9d;EN组 :术前放置营养管在胃内 ,术后常规补液 ,肠蠕动恢复后 ,由营养管注入要素膳 ,每日 30 0 g。对照组 ,术后给以常规补液 (1 0 %葡萄糖溶液 2 50 0 ml/d,5%葡萄糖盐水 1 0 0 0 ml/d) ,由周围静脉连续静点 8～ 9d。比较指标 :对体重、氮平衡、血浆白蛋白、血常规进行了测定 ,并对术后并发症的发生情况进行比较。结果　本研究组病人无手术死亡和吻合口瘘发生 ,测定指标比较 ,PN组和 EN组明显优于对照组。结论　经腹贲门癌手术后的患者、肠内或肠外营养支持是必要的。     

重型颅脑损伤后早期肠内营养相关并发症分析

目的:观察重型颅脑损伤后早期肠内营养(EN)相关并发症的发生特点、相关因素及防治措施.方法:360例接受早期肠内营养支持的重型颅脑损伤病人,入住ICU后进行GCS评分,置鼻胃(肠)管,48 h后开始EN,观察伤后第7 d EN最大输注量(mL/d)、过渡至完全肠内营养(TEN)的时间(d)、伤后第7 d实现TEN的病例数及血糖和血清清蛋白(ALB)和谷丙转氨酶变化,记录各种肠内营养并发症的发生率.结果:颅脑损伤后早期EN并发症发生特点:伤后1周内以腹胀、呕吐、反流和误吸为主,1周后以腹泻为主;腹胀和呕吐的发生与鼻饲管所在位置有关,腹泻发生与GCS评分和ALB水平呈负相关;GCS评分越低,EN耐受的最大输注量越低、过渡至TEN的时间越长、相关并发症的发生率亦增加.结论:重型颅脑损伤后早期肠内营养相关并发症与其损伤程度、血清清蛋白水平等因素呈负相关;使用鼻肠管可降低腹胀和呕吐的发生率.     

Enteral glutamine during active shock resuscitation is safe and enhances tolerance of enteral feeding

BACKGROUND: Feeding the hemodynamically unstable patient is increasingly practiced, yet few data exist on its safety. Because enteral glutamine is protective to the gut in experimental models of shock and improves clinical outcomes, it may benefit trauma patients undergoing shock resuscitation and improve tolerance if administered early. This pilot study aimed to evaluate gastrointestinal tolerance and safety of enteral feeding with glutamine, beginning during shock resuscitation in severely injured patients. METHODS: In a prospective randomized trial, 20 patients were randomly assigned to either an enteral glutamine group (n = 10) or a control group (n = 10). Patients with severe trauma meeting standardized shock resuscitation criteria received enteral glutamine 0.5 g/kg/d during the first 24 hours of resuscitation and 10 days thereafter. Immune-enhancing diet began on postinjury day 1, with a target of 25 kcal/kg/d. Control patients received isonitrogenous whey powder plus immune-enhancing diet. Tolerance (vomiting, nasogastric output, diarrhea, and distention) was assessed throughout the study. RESULTS: Glutamine was well tolerated and no adverse events occurred. Treated patients had significantly fewer instances of high nasogastric output (5 vs 23; p = .010), abdominal distention (3 vs 12; p = .021), and total instances of intolerance (8 vs 42; p = .011). Intensive care unit (ICU) and hospital length of stay were comparable. Control patients required supplemental parenteral nutrition (PN) to meet goals at day 7. CONCLUSIONS: Enteral glutamine administered during active shock resuscitation and through the early postinjury period is safe and enhances gastrointestinal tolerance. A large clinical trial is warranted to determine if enteral glutamine administered to the hemodynamically unstable patient can reduce infectious morbidity and mortality.     

Proinflammatory cytokine production by mitogen-stimulated peripheral blood mononuclear cells (PBMCs) in trauma patients fed immune-enhancing enteral diets

Widespread metabolic changes associated with injury facilitate the delivery of nutrients to the immune system. The effect of specific nutrients administered by the enteral route on the immune response in trauma victims is not well understood. The purpose of this study was to examine whether the synthesis of proinflammatory cytokines (tumor necrosis factor-alpha [TNF-alpha], interleukin-1 beta [IL-1 beta], and interleukin-6 [IL-6]) by peripheral blood mononuclear cells (PBMCs) are influenced by the nature of the dietary fat in critically injured trauma victims. We measured plasma TNF-alpha, IL-1 beta, and IL-6 and their release stimulated by phytohemagglutinin (PHA) and endotoxin (lipopolysaccharide, LPS) from PBMCs of 13 severely injured (injury severity score = 30 +/- 2) patients once within 48-60 h after injury and then after 7 d of enteral feeding (1.5 g protein[P].kg-1.d-1). Group I (n = 6) received diet A (Crucial) and group II (n = 7) received diet B (Impact). The plasma levels of TNF-alpha and IL-1 beta in trauma patients are not significantly different from those in healthy volunteers, but plasma IL-6 levels are significantly increased (five times) in severely injured patients. Stimulation of TNF-alpha and IL-1 beta secretion by LPS and PHA were significantly higher in patients than in control subjects; in contrast, there was no stimulation of IL-6 because of trauma or nutritional support by either of the diets. Stimulation of IL-1 beta by LPS was normalized by Crucial but was further enhanced by Impact. The higher fat content in Crucial may contribute in part to the apparent immunomodulation. Crucial seems to be a better choice in correcting the nutritional deficiency.     

The route of administration (enteral or parenteral) affects the conversion of isotopically labeled L-[2-15N]glutamine into citrulline and arginine in humans

BACKGROUND: Glutamine exhibits numerous beneficial effects in experimental and clinical studies. It has been suggested that these effects may be partly mediated by the conversion of glutamine into citrulline and arginine. The intestinal metabolism of glutamine appears to be crucial in this pathway. The present study was designed to establish the effect of the feeding route, enteral or parenteral, on the conversion of exogenously administered glutamine into citrulline and arginine at an organ level in humans, with a focus on gut metabolism. METHODS: Sixteen patients undergoing upper gastrointestinal surgery received an IV or enteral (EN) infusion of L-[2-(15)N]glutamine. Blood was sampled from a radial artery and from the portal and right renal vein. Amino acid concentrations and enrichments were measured, and net fluxes of [(15)N]-labeled substrates across the portal drained viscera (PDV) and kidneys were calculated from arteriovenous differences and plasma flow. RESULTS: Arterial [(15)N]glutamine enrichments were significantly lower during enteral tracer infusion (tracer-to-tracee ratio [labeled vs unlabeled substrate, TTR%] IV: 6.66 +/- 0.35 vs EN: 3.04 +/- 0.45; p < .01), reflecting first-pass intestinal metabolism of glutamine during absorption. Compared with IV administration, enteral administration of the glutamine tracer resulted in a significantly higher intestinal fractional extraction of [(15)N]glutamine (IV: 0.15 +/- 0.03 vs EN: 0.44 +/- 0.08 micromol/kg/h; p < .01). Furthermore, enteral administration of the glutamine tracer resulted in higher arterial enrichments of [(15)N]citrulline (TTR% IV: 5.52 +/- 0.44 vs EN: 8.81 +/- 1.1; p = .02), and both routes of administration generated a significant enrichment of [(15)N]arginine (TTR% IV: 1.43 +/- 0.12 vs EN: 1.68 +/- 0.18). This was accompanied by intestinal release of [(15)N]citrulline across the PDV, which was higher with enteral glutamine (IV: 0.38 +/- 0.07 vs EN: 0.72 +/- 0.11 micromol/kg/h; p = .02), and subsequent [(15)N]arginine release in both groups. CONCLUSIONS: In humans, the gut preferably takes up enterally administered glutamine compared with intravenously provided glutamine. The route of administration, enteral or IV, affects the quantitative conversion of glutamine into citrulline and subsequent renal arginine synthesis in humans.