The Impact Of Alanyl-glutamine-enriched Enteral Nutrition On Immune Function Of Postoperative Patients

Purpose: To evaluate the impact of alanyl-glutamine-enriched enteral nutrition on immune function of postoperative patients. Subjects and Methods: A randomized, controlled clinical trials were performed. Thirty-two patients undergoing major abdominal surgery joined this study, 30 patients have completed the 8 days study. There were 3 groups: PN group was received conventional parenteral nutrition; EN group was fed with enteral nutrition; GLN group was fed with alanyl-glutamine-enriched enteral nutrition. The patients were received parenteral nutrition/enteral nutrition from the 3 th postoperative day to the 10^th postoperative day. All patients received isonitrogenic (0.2gN/kg/day) and isocarloric (2Kcal/kg/day). The peripheral lymphocyte proportion and immunogloblin levels were measured; hospital stay and nutritional support cost were monitored.Result: The levels of body humoral immune parameters and cell immune parameters were comparable. 1.The plasma IgG, IgM in the PN group on POD+11 were significantly lower than that of preoperative levels (P=0.04). In the both of enteral nutrition groups were similar to the preoperative level. 2. The CD3+, CD4+, CD4+/CD8+ ratios of POD+11 were lower than that of preoperative in the PN group, but these were resumed in the EN/GLN group. The delta of POD+11 and AOD of lymphocytes subset proportion (CD3+, CD4+, CD4+/CD8+) were significantly decreased in the PN group (P=0.004, 0.0001, 0.006, respectively). The delta of POD+11 and AOD of CD25+cell in the GLN group was higher than that of PN/EN group (P=0.01, 0.07). No severely adverse reaction related with parenteral or enteral nutrition was observed, but serum total bilirubin was elevated in PN group. The postoperative nutritional support cost was significantly more in the PN group (P=0.0001).