Glutamine-enriched enteral feeding in trauma patients: reduced infectious morbidity is not related to changes in endocrine and metabolic responses.

摘要

BACKGROUND: Recently we have shown that glutamine-enriched enteral nutrition in trauma patients reduced the occurrence of pneumonia, bacteremia, and sepsis. In that study, no clear explanation for these results was found except for lower tumor necrosis factor (TNF)-soluble receptors, suggesting immunomodulation. Here we present data on the course of endocrine and metabolic plasma mediators that were analyzed to provide more insight into the working mechanism of glutamine. METHODS: Endocrine and metabolic mediators were measured in plasma samples taken on admission (day 0) and on days 1, 2, 3, 7, and 10. Glucose, prealbumin, albumin, alanine, C-reactive protein, alpha1-antitrypsin, complement factors, cortisol, glucagon, insulin, and growth hormone were assessed by standard techniques. RESULTS: The rate of feeding, demography, and injury severity did not differ between the glutamine and control group. There was a sustained hyperglycemic response in both groups. Insulin levels rose in the second phase of the period of observation. A moderate cortisol and glucagon response was seen in both groups. There was no alteration in growth hormone levels in either group. C-reactive protein, alpha1-antitrypsin, and complement factors showed similar increases in both groups but levels remained in the normal range. The course of alanine, albumin, and prealbumin also showed no difference between the groups. CONCLUSIONS: Glutamine-enriched enteral nutrition had no influence on the endocrine and metabolic response in trauma patients. Therefore, the reduction in infectious morbidity seen in glutamine-supplemented trauma patients is most likely not explained by a modulation of the humoral stress response and its metabolic consequences.