Influence of alanyl-glutamine-enriched enteral nutrition on intestinal permeability of patients with abdominal surgical stress response / 第二军医大学学报

ABSTRACT

Objective: To investigate the influence of alanyl-glutamine-enriched enteral nutrition on the intestinal permeability in patients with abdominal surgical stress response. Methods: A total of 216 patients undergoing abdominal surgery were randomly divided into three groups, namely, the conventional alanyl-glutamine-enriched enteral nutrition (GLN group), enteral nutrition (EN group) and parenteral nutrition(PN group). The three groups were given isonitrogenic (0.2g · kg-1 · d-1) and isocarloric (125.4 kJ · kg-1 · d-1) support during 3-11 days after operation. The urinary lactulose/mannitol (L/M) ratios were observed 6 h after the patients were given 10 g lactulose and 5 g mannitol on one day before and the 7th, 12th day after operation. High pressure liquid chromatography was used to determine the urinary levels of lactulose and mannitol. Results: The mannitol levels had no significant change before and 7, 12 days after operation in the 3 groups, and there were also no significant difference between the 3 groups before and 7, 12 days after operation. The L/M values before and 7, 12 days after operation were 0.025±0.009, 0.038±0.017, and 0.028±0.012 in GLN group, 0.024±0.011, 0.061±0.019, and 0.027±0.014 in EN group, and 0.026 ± 0.012, 0.083 ± 0.021, and 0.047 ± 0.013 in PN group, respectively. Statistical analysis showed that the L/M ratios in the 3 groups were all significantly increased 7 days after operation compared with those before operation (P<0.05), and that of PN group was significantly higher than those of EN group and GLN group (P<0.05), and that of EN group was significantly higher than that of GLN group (P<0.05). Twelve days after operation, the L/M ratios in PN group was still significantly higher than that before operation and those in the EN and GLN groups (P<0.05), and that in EN group was similar to that before operation and that in GLN group. Conclusion: The intestinal permeability is greatly increased during the early period after operation. Enteral nutrition is favorable for maintaining the function of intestinal mucosal barrier. Alanyl-glutamine-enriched enteral nutrition can improve the function of intestinal mucosal barrier.