| BACKGROUDS & AIMS:Obstructive jaundice (OJ) is a common disease of hepatobiliary surgery department, and its treatment is always difficult. Infection, dysfunction of liver and kidney and even systemic inflammatory response syndrome(SIRS) and multiple organs dysfunction syndrome(MODS) are commonly seen after operation,which make a bad prognosis.However,the mechanism is not fully understand yet. Generally speaking, the endotoximia and immunological dysfunction is the main cause.Immunonutrition can stimulate immune cells to strengthen response, maintain appropriate immunological response, control the production and release of cytokins, alleviate harmful or excessive inflammatory response, maintain normal gut barrier function etc..So far some immunonutrients are clinically used,and they give a bright future.Gut–based endotoximia frequently occurres in obstructive jaundice,which stimulates the macrophage to release TNF -ɑ, that prohibit the immue function of the body.Under pathologic status it can cause fever ,shock and MODS etc ..Soluble interleukin-2 receptor(sIL-2R) is a kind of polypeptide released by activated lymphocyte and monocyte ,which is a important immnosuppression substance .It is a sensitive marker of activated immune system . The level of sIL-2R is obviously increased in obstructive jaundice ,indicating immune system suppressed ,and this is partly the reason of obstructive jaundice patients liable to infection and sepsis and MODS . The animal experiment and clinical application indicates that immunonutrients such as glutamine and arginine can improve the immune status . We establish obstructive jaundice model of Wister rats by ligation of common bile duct ,then compare the liver function (TB,DB,ALT,ALP),TNF-ɑ and sIL-2R on the 3rd,7th,14th postoperative day of common feeding group(OJ group ) and 5%-glutamine supplemented feeding group(OJ +Glu group ) .MATERIALS & METHODS:60 healthy Wister rats were randomly divided into 3 groups : normal group(N group) 6 rats;sham operation group (SO group )18 rats ,common bile duct ligation group (OJ group )and common bile duct ligation with 5% glutamine feeding group (OJ +Gln group ) 18 rats respectively .The later 3 group were randomly divided into 3 subgroups by postoperative time (3d ,7d ,14d ),6 rats each group .Nothing was done on normal rats .The other 3 groups were anesthetized by Ketamine 2ml/kg .The rats of SO group underwent laparotomy, common bile duct (CBD) was not actually ligated and transected.The rats of OJ group and OJ+Gln group underwent laparotomy, CBD ligation and transection.N group,SO group and OJ group were standardly fed after operation ,while the OJ +Gln group were fed a 5% glutamine supplemented enteral diet .All the rats were sacrificed on expected time and wait for the detection of TB, DB, ALT, ALP by automatical biochemical detecting machine and TNF-ɑ,sIL-2R by ELISA kits.RESULTS:No significant difference was found in SO group and N group of liver function .But there was significant difference between OJ group ,OJ +Gln group and SO group (P <0.01).The 4 liver function markers of OJ +Gln group were far lower than those of OJ group (P <0.05).Serum TNF-ɑ increased in OJ group and OJ+Gln group than SO group (P<0.01).And it was higher on the 14th postoperative day than that on the 3rd day (P<0.01).And there was significant difference between OJ group and OJ+Gln group (P<0.01) ,it was far lower in OJ+Gln group .Of the serum sIL-2R it was obviously higher in OJ group and OJ+Gln group compared to SO group (P<0.01).And it was lower in OJ+Gln group than that of OJ group (P<0.05).CONCLUSIONS:These findings suggest that oral administration of a glutamine supplemented diet can improve the immune status and relieve the damage of endotoximia.But the level of those markers are still too high in rats fed a 5% glutamine supplemented diet.Clinically we should try to remove the etiological factors as early as possible ,then use all the possible measures to improve the immune function .Thus we can improv...
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