Effect Of Glutamine On The Barrier Function Of The Intestinal Mucosa Of The MODS Patients

Objective: Through the clinical application observision to MODS patients divided into TPN group and glutamine dipetide treatment group, this thesis will probe into the effect of glutamine on the barrier function of the intestinal mucosa of the MODS patients.Methods: 40 MODS patients in the ICU from September 2003 to June 2005 were randomed, double-blinded and checked into routine group (Group A, n=20), the glutamine dipeptide+TNP Treatment Group (Group B, n=20). The two groups of patients received treatment of parenteral nutrition with equal nitrogen and equal calorie. The patients received 20Kcal/kg and nitrogem of 0.2g/kg daily. Group A were given routine TPN, and Group B were given routine and glutamine dipeptide 0.4g/kg daily(i.e. glutamine 0.27g/kg) for seven days. The density of plasma glutamine, DAO, D-lactate and LPS, the treatment time and the death rate of the two groups were checked before the treatment of TPN, on the first day, the third day and the seventh day of the treatment of TPN. At the same time 20 healthy blood donators were chosen as the healthy control group (Group C). All the data were counted and analyzed with the SPSS10.0 software.Result: Before treatment the density of plasma glutamine of the two patient groups were both apparently lower than that of the control group (Group C) (p<0.01), with that of Group A was 0.380mmol/L, Group B of 0.374 mmol/L, and Group C of0.669mmol/L;and there was no apparent difference between that of Group A and that of Group B (p>0.05). On the first day and the third day of the treatment of TPN, the density of plasma glutamine of Group A began to decrease, and the density of plasma glutamine of Group B began to increase, and the difference was clear (p<0.01);on the seventh day of the TPN treatment, the density of plasma glutamine of Group A was 0.377mmol/L, the density of plasma glutamine of Group B was 0.568 mmol/L, and the density of Group A was clearly lower than that of Group B (pO.Ol). The density of plasma glutamine was close to the normal (pO.Ol). Before treatment the density of plasma DAO, D-lactate and LPS of the two patient groups were apparently higher than that of Group C, with the result of 3.761 u/ml, 4.314 mg/L, and 0.197 Eu/ml correspondingly for Group A, and the result of 3.753 u/ml, 4.369 mg/L, and 0.196 Eu/ml correspondingly for Group B, and the result of 1.175 u/ml, 1.696 mg/L, and 0.086 Eu/ml correspondingly for Group C;after the treatment of glutamine dipeptide plus TPN, the density of plasma DAO, D-lactate and LPS of Group B was apparently lower than that of Group A (p<0.01);on the seventh day of the TPN treatment, the density of plasma DAO, D-lactate and LPS of Group B was 1.752 u/ml, 2.277 mg/L, and 0.126 Eu/ml correspondingly, which were still higher than the normal. The TNP treatment time was 15.8 ± 2.3 days for Group A, 12.5 ± 2.4 days for Group B. The time for Group A is clearly higher than that of Group B (p<0.05). The death rate of Group A was 25%, the death rate of Group B was 10%, and there was no clear difference between the two groups (p>0.05).Conclusion: The glutamine dipeptide complementarity through vein can help to improve the recovery of plasma glutamine level,to increase the supply of energy accommodate of intestinal mucosa epithelium,and to decrease the density of plasma DAO, D-lactate and endotoxin. It has important effect in protecting the intestinal mucosa epithelium function. It also helps to shorten the TPN treatment time.