丙氨酰-谷氨酰胺对多器官功能障碍综合征患者的肠黏膜保护作用

目的探讨添加丙氨酰-谷氨酰胺的全肠外营养(TPN)对多器官功能障碍综合征(MODS)患者的肠黏膜屏障功能的影响。方法将入住本院ICU的MODS患者56例,均分为丙氨酰-谷氨酰胺双肽组(治疗组)和常规TPN组(对照组)。2组患者均接受等氮、等热量的肠外营养治疗。对照组按常规TPN,治疗组在给予TPN基础上加用L-丙氨酰-I-谷氨酰胺0.4 g/(kg.d),共7 d。所有患者均于TPN治疗前及治疗后第1、3、7天检测血浆二胺氧化酶(DAO)、D-乳酸、内毒素(LPS)浓度,观察分析营养指标,测血浆DAO、D-乳酸和LPS浓度。结果治疗组治疗后血浆DAO、D-乳酸和LPS浓度各项指标显著低于对照组;治疗组营养指标明显高于治疗前和对照组,对照组仅转铁蛋白较治疗前增高。结论应用丙氨酰-谷氨酰胺的肠外营养能够明显纠正MODS患者的营养代谢障碍,增加患者肠黏膜上皮细胞能量供给,保护肠黏膜上皮细胞功能。

Intestinal mucosa protection of alanyl-glutamine on posttraumatic multiple organ dysfunction syndrome

Objective To explore the impact of multiple organ dysfunction syndrome(MODS) in patients with intestinal mucosal barrier function by adding alanyl-glutamine in total parenteral nutrition(TPN).Methods Fifty-six ICU patients with MODS were included in the study.Patients were divided into alanyl-glutamine dipeptide group(treatment group,n=26) and conventional TPN group(control group,n=28).The two groups received nitrogen and calorie parenteral nutrition therapy.The control group received conventional TPN,and the treatment group received TPN in addition to L-C aminoacyl-I-glutamine 0.4 g/(kg·d),a total of 7 days.All patients were detected in plasma diamine oxidase(DAO),D-lactic acid,the concentration of endotoxin(LPS) on TPN before treatment and days 1,3,7 after treatment.The nutritional indicators, plasma DAO,D-lactate and LPS concentration were observed and analyzed.Results After treatment,the plasma DAO,D-lactate and LPS concentration of the indicators in the treatment group were significantly lower than those of the control group.Nutritional indicators in the treatment group were significantly higher than those in the control group.Only transferrin levels in the control group was higher than that before treatment.Conclusion Application of alanyl-glutamine parenteral nutrition can significantly correct the MODs nutrition in patients with metabolic disorders,increase intestinal epithelial cells energy supply,and protect intestinal epithelial cell function.