Perioperative Alanyl-Glutamine-Supplemented Parenteral Nutrition in Chronic Radiation Enteritis Patients With Surgical Intestinal Obstruction: A Prospective, Randomized, Controlled Study

摘要

Background: A prospective, randomized, controlled study was performed to evaluate the effects of perioperative alanyl-glutamine-supplemented parenteral nutrition (PN) support on the immunologic function, intestinal permeability, and nutrition status of surgical patients with chronic radiation enteritis (CRE)-induced intestinal obstruction. Methods: Patients who received 0.4 g/kg/d alanyl-glutamine and isonitrogenous PN were assigned to an alanyl-glutamine-supplemented PN (Gln-PN) group and a control group, respectively. Serum levels of alanine aminotransferase and glutamine, body fat mass (FM), immunologic function, and intestinal permeability were measured before and after surgery. Results: Serum glutamine levels of the Gln-PN group significantly exceeded that of the control group (P < .001; Gln-PN, baseline 460.7 +/- 42.5 vs 523.3 +/- 48.6 mu mol/L on postoperative day 14 [POD14], P < .001; control, baseline 451.9 +/- 44.0 vs 453.8 +/- 42.3 mu mol/L on POD14, P = .708). Lactulose/mannitol ratios of both groups decreased over time (Gln-PN, baseline 0.129 +/- 0.0403 vs 0.024 +/- 0.0107 on POD1 4; control, baseline 0.125 +/- 0.0378 vs 0.044 +/- 0.0126 on POD14, P < .001 in both groups). CD4/CD8-positive T-lymphocyte ratios significantly rose in both groups, with significant intergroup difference (P < .001; Gln-PN, baseline 1.36 +/- 0.32 vs 1.82 +/- 0.30 on POD14, P < .001; control, baseline 1.37 +/- 0.25 vs 1.63 +/- 0.31 on POD14, P < .001). In the Gln-PN group, FM increased from 3.68 +/- 1.68 kg at baseline to 5.22 +/- 1.42 kg on POD14 (P < .001). FM of control group increased from 3.84 +/- 1.57 kg at baseline to 5.40 +/- 1.54 kg on POD14 (P < .001). However, there were no significant intergroup differences (P = .614). Conclusion: Gln-PN significantly boosted the immune state and decreased the intestinal permeability of CRE patients. However, Gln-PN was not superior to standard PN in improving the nutrition state and intestinal motility of surgical patients with CRE-induced intestinal obstruction.