富含谷氨酰胺的新型20种结晶氨基酸组成的全肠外营养在大鼠小肠切除的应用研究

Influence of glutamine-supplemented parenteral nutrition on rats after small bowel resection

目的应用Wistar大鼠小肠大部切除和肠外营养模型，重点研究富含谷氨酰胺和支链氨基酸的新型20种结晶氨基酸对大鼠肠粘膜形态结构、机体免疫功能状态及TNF的动态变化。方法40只Wistar大鼠随机分为虚拟对照组、无氮组、20种氨基酸和17种氨基酸组。虚拟对照组为空肠上段距屈氏韧带10cm处横断，以5－0丝线端端吻合，该组口服常规的大鼠饲料，液体由中心静脉输注。后三组切除75％的小肠，空肠上段及回肠末段分别剩余15cm及10cm肠段，残端对端吻合，无氮组能量由脂肪乳和葡萄糖组成的TPN经中心静脉供给，20种氨基酸组和17种氨基酸组及虚拟对照组等氮，四组动物非蛋白热卡相等。术后隔日称体重。术后4、7天收集粪尿测氮平衡，术后第8天眼眶采血测肝功能、TNF、纤维结合蛋白、前白蛋白及Th／Ts，鼠尾无菌采血测淋巴细胞转化率，处死动物后计算脏器指数，采集肠粘膜标本，测定肠粘膜DNA、RNA含量，观察粘膜形态结构，测量粘膜厚度与绒毛高度。结果20种氨基酸组、17种氨基酸组、虚拟对照组测得的各项指标均明显优于无氮组（P＜0．05）。20种氨基酸组和虚拟对照组其体重丢失、氮平衡及空肠粘膜形态均好于17种氨基酸组；血清白蛋白、TNF、Th/Ts、T淋巴细胞转化率及空肠粘膜厚度绒毛高度和其DNA。

Purpose To investigate the effect of glutamine and BCAA on rats after massive small bowel resection (SBR). Methods: After central catheterization,40 Wistar rats were randomly assigned into one of the four groups. A sham control group of rats (n = 8) were given a sham operation involving transaction and reanastomosis of the jejunum 10cm distal to the ligament of Treis, this group were given a standard rat food diet,water was given by central vena cave. The second group of rats (n = 8) were given an 75% midgut resection, leaving 15cm of the proximal jejunum and 10cm of the distal ileum. Bowel continuity was restored by an end-to-end jejunoileal anastomosis of interrupted 5~0 silk sutute, this groups was not given amino acid and protein, glucose and intralipid were given by central vena Cava. The other two SBR groups underwent the same operation as that of the second group and were divided into 17 amino acids TPN group (n = 12) and 20 amino acids group TPN (n = 12). The first group and the third group and the fourth group were isonitrogenous, the all four groupe were isocaloric. The body weight,liver function, nitrogen balance,jejunal mucosal morphalogy,the total DNA and RNA of jejunal mucosal cells, fibronection, T lymphocyte blastogenesis stimulated by ConA Th/Ts, the serum TNF were measured. Results The results showed that all variable in sham control group and 20 AA group and sham control group had better body weight, nitrogen balance and jejunum morphology than 17AA group. The serum albmin and TNF,Th/Ts and T lyrmphocyte blastogenesis stimulated by ConA in 20 AA group was increased compared with 17 AA group (P < 0. 05), but total protein and fibronection was not observed remarkable difference between 20 AA and 17 AA groups. Conclusions The result showed that 20AA TPN group had better nutritional support, enhancing immunity, passive nitrogen balance can be improved. It appears that 20 AA TPN could b provided to maintain and Support growth of the gastrointestinal mucosa.