A Clinical Research Of The Relationship Among Glutamine, Intestinal Permeability And Bacterial Translocation After Abdominal Operation

AIM: To approach the relationship among the glutamine level, the intestinal mucosa permeability and the bacterial translocation, and investigate the connection between bacterial translocation (BT) and systemic inflammatory response syndrome (SIRS) after abdominal operation.METHODS: To select 42 patients undergoing major, modenante surgery on abdominal region, and detect their Gln concentration, the ratios of lactulose/ mannitol, the percentage of bacterial DNA presenting in peripheral blood separately (before surgery, postoperative 2nd and 7th day). The types of operation and the incidence rate of SIRS after operation were recorded.RESULTS: The Gln concentration in blood plasma was 636.186±113.979 vs473.245 ±117.925 vs 549.526±118.374 mmol/L(before surgery, postoperative 2nd and 7th day), the postoperative Gin concentration was lower than the preoperative Gin concentration(P<0.01). The ratio of lactulose/ mannitol was 0.022 ± 0.004 vs 0.069 ± 0.021 vs 0.029 ±0.011. The postoperative ratio of lactulose/ mannitol was higher than the preoperative ratio (P<0.01). No bacterial DNA was detected before surgery, but there were 4 positive patients (9.5%, 4/42) on the 2nd day after surgery, and there was one patient (2.4%, 1/42) on the 7th. The postoperative Gin concentration in blood plasma of PCR positive patients was decreased more significantly than that of PCR negative patients (P<0.01), the postoperative ratio of lactulose/ mannitol in PCR positive patients was higher than PCR negative patients' (P<0.01). Moreover, No difference was found between gastro-intestinal operation and non-gastrointestinaloperation about the PCR positive rate (P>0.05). In 42 patients, SIRS patients were 26, and non-SIRS patients were 16 after operation. The postoperative Gln concentration of SIRS patients was 433.798 ± 88.778mmol/L and it was 554.600 ± 52.139mmol/L in non-SIRS patients. The ratio of lactulose/ mannitol was 0.072 ± 0.027 vs 0.061 ± 0.029 between SIRS patients and non-SIRS patients. The postoperative Gln concentration of SIRS patients was remarkably cut down (P<0.01), and the ratio of lactulose/ mannitol was visibly stepped up in SIRS patients (P<0.01). 5 PCR positive results took place in SIRS patients, PCR positive results weren't found in non-SIRS patients.CONCLUSIONS: There is a close correlation among the decrease of glutamine, the increase of the intestinal mucosa permeability and bacterial translocation, Gln play possiblly a significant part in protecting the intestinal mucosa barrier function and decreasing bacterial translocation from intetine.