Glutamine and recombinant human growth hormone protect intestinal barrier function following portal hypertension surgery.
OBJECTIVE
To evaluate the effects of combined treatment of glutamine (Gln) and recombinant human growth hormone(rhGH) on intestinal barrier function following portal hypertension surgery.


METHODS
This study was designed as a prospective, randomized and controlled clinical trial. Forty two patients after portal hypertension surgery were randomly assigned into 2 groups: control group (n = 20) and supplemental group (adding Gln and rhGH, n = 22). Every patient received isocaloric and isonitrogenous standard total parenteral nutrition (TPN) starting 3 d after surgery for 7 d. Blood samples were obtained before surgery and at the 3rd and 10th day postoperatively. Host immunity was evaluated by measuring levels of CD4, CD8, CD4/CD8, IgG, IgM and IgA, and the inflammatory responses were determined by assessing IL-2, TNF-alpha and C-reactive protein (CRP) levels. Intestinal permeability and integrity was evaluated by L/M test and histological examination, respectively.


RESULTS
On postoperative d 10, CD4, CD4/CD8, IgG and IL-2 levels in supplemental group were significantly higher than those in control group (33.7 +/- 5.5 vs 31.0 +/- 5.4, P < 0.05, (1.17 +/- 0.32 vs 1.05 +/- 0.15, P < 0.05, 13.94 +/- 1.09 vs 12.33 +/- 1.33, P < 0.05, and 368.12 +/- 59.25 vs 318.12 +/- 45.65, P < 0.05, respectively), whereas the increase in serum TNF-alpha concentration was significantly reduced (41.02 +/- 27.56 vs 160.09 +/- 35.17, P < 0.05). The increase in L/M ratio was significantly lower in the supplemental group than in the control group (0.0166 +/- 0.0017 vs 0.0339 +/- 0.0028, P < 0.05). Moreover, mucosal integrity in the supplemental group was better than in the control group.


CONCLUSIONS
Postoperative administration of TPN supplemented with Gln and rhGH in patients after portal hypertension surgery improves immune function, modulates inflammatory response, prevents the intestinal mucous membrane from atrophy and preserves intestinal integrity.
Tang
Zhao-Feng
ZF
Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong Provice, China.
Ling
Yun-Biao
YB
Lin
Nan
N
Hao
Zheng
Z
Xu
Rui-Yun
RY
D000328:Adult; D001284:Atrophy / Q000517:prevention & control; D002097:C-Reactive Protein / Q000378:metabolism; D002463:Cell Membrane Permeability / Q000187:drug effects / Q000502:physiology*; D004359:Drug Therapy, Combination; D005260:Female; D005973:Glutamine / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D007136:Immunoglobulins / Q000097:blood; D007376:Interleukin-2 / Q000097:blood; D007408:Intestinal Absorption / Q000187:drug effects / Q000502:physiology*; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology / Q000502:physiology; D007792:Lactulose / Q000097:blood; D008297:Male; D008353:Mannitol / Q000097:blood; D008875:Middle Aged; D018809:Proliferating Cell Nuclear Antigen / Q000097:blood; D011994:Recombinant Proteins / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D007136:Immunoglobulins; D007376:Interleukin-2; D018809:Proliferating Cell Nuclear Antigen; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; D005973:Glutamine; D019382:Human Growth Hormone; D008353:Mannitol; D007792:Lactulose; D002097:C-Reactive Protein