谷氨酰胺、胆囊收缩素预防胃肠外营养期间胆汁瘀积的动物实验研究

目的探讨谷氨酰胺(GLN)／胆囊收缩素(CCK)，在完全胃肠外营养(TPN)支持期间预防胆汁瘀积的作用，分别阐明GLN和CCK在预防胆汁瘀积中的作用机制及其相互关系。

The role of glutamine and C. C. K in preventing cholestasis during PN

Objective Purpose: Study Glutarnine (GLN)/Cholecystokinin (CCK)'s action of preventing cholestasis during total parenteral nutrition (TPN) and detail action mechanism of GLN and CCK and relationship between each other. Methods Adopt Newzealand pure species white hares as TPN models. All hares were divided into four teams, in which 1st team was designated as TPN team, 2nd team as TPN + GLN team, 3rd team as TPN + CCK team, and 4th team as TPN + GLN + CCK team. Each team was divided into two halves in turn. One half were killed after four-week observation and the other half were killed after 8 weeks. Through blood biochemical examination, analysis of chole components, observation of macrostructure, scan of light and esectron microecopes, we observed if there were cholestasis, gallbladder constmctural alteration and its degree. Results Through blood monitoring, increases of GPT. AKP. cholehilirubin and cholesterol were observed in the first team as compared with the second to forth teams at the forth week and higher increases were found at the 8th week. In choletest,cholebilirubin and cholesterol were higher in the first and second teams than in the third and fourth ones at the 4th week and were higher instinctively in the first to third teams than in the forth team at the 8th week. Scan of light and electron microscopes demonstrated that cholepithelia became low-column shape. Dyeing was deepened. There was cytoedema and mitochondrial got swelling at the 4th week in the first and third teams. At the 8th week, there was tissue between lamina propria and muscle layer. Cyto-plasm became muddy, in which there were bigger fatty drops. There were vacuity in cytoreticulum. In the second and forth teams, we found normal cell density at the 4th week. At the 8th week, there was small alteration in the second team and normal density in the forth team. Conclusions It is true that cholestasis will take place during TPN and become serious with time prolonging. Integrality and function of choleeystis, wall tissue cell can be defended and sustained by applying TPN and GLN, but there is no direct preventing action. There are apparent cholecystokinetic and cholagogic functions by applying TPN + CCK. But CASK will lose its function if cholecystis-wall is damaged. There are not only preventing and sustaining functions for the integrality and function of cholecystis-waU tissue cell but also apperent function of chole constriction and cholegogue by applying TPN + GLN + CCK. It is proved to be the best way to prevent cholestasis during. T. P. N.