谷氨酰胺颗粒对重度慢性乙型病毒性肝炎患者肠道通透性、内毒素血症与肝功能的影响

Effects of glutamine on intestinal permeability, endotoxemia and liver function in severe chronic hepatitis B patients

目的:研究谷氨酰胺颗粒对重度慢性乙型病毒性肝炎患者肠黏膜通透性异常、内毒素血症及肝功能的影响,并探讨其病理生理机制.方法:60例重度慢性乙型病毒性肝炎患者随机分为对照组和实验组.每组各30例.对照组采用常规护肝,抗病毒治疗,而实验组在对照组治疗方案的基础上加用谷氨酰胺颗粒10g,tid,疗程为2wk.于治疗前后采用自动生化分析仪分别测定2组患者的肝功能,包含ALT、AST、TBIL、PT、ALB,胆碱酯酶(CHE)等;同时于治疗前后采用鲎实验法测定血清内毒素(ET),高效液相色谱蒸发光散射器(HPLC-ELSD)法测定尿乳果糖和甘露醇排泄率的比值(L/M).并加以比较.结果:2wk治疗后,2组患者的肝功能、ET、L/M水平均较治疗前有不同程度的好转(P<0.05或0.01).与对照组治疗前后ALT、TBIL、CHE、ET、L/M的差值比较,治疗组治疗前后各指标的差值更为显著(281.86±149.34Uvs199.65±127.09U,168.65±102.04μmol/Lvs94.13±172.67μmol/L,-1301.04±662.78Uvs-892.23±861.41U,0.0198±0.0128vs0.0089±0.0228,均P<0.05).结论:谷氨酰胺颗粒能够起到保护肠上皮细胞,纠正重度慢性乙型肝炎患者肠黏膜通透性异常,改善肠源性内毒素,加速肝功能恢复的作用.

AIM： To study the effect of glutamine on intestinal permeability, endotoxemia and liver function in severe chronic hepatitis B patients. METHODS： Sixty cases with severe chronic hepatitis B were randomly divided into two groups,the control group and the experimental group, with 30 cases in each group. For control group, the patients were given regular treatment, including hepatic protectants and anti-virology therapy. For experimental group, the patients were given extra glutamine 10 g tid in addition to regular treatment. The whole treatment duration lasted two weeks. Before and after treatment, patients in each group all undertook liver function test （ALT, AST, TBIL, PT, ALB, CHE） respectively. Meanwhile, the serum endotoxin （ET） level was measured by limulus lysate test, and the change of intestinal permeability by urine lactulos/mannitol ratio （L/M） were detected by high performance liquid chromatography with evaporative light scattering detector （HPLC-ELSD）. RESULTS： After 2 weeks＇ treatment, the total tests of liver function, serum endotoxin level, L/M showed positive changes in both of the experimental and control groups （P 〈 0.05 or 0.01）. Compared with the control group, the positive changes of ALT, TBIL, CHE, ET, L/M between pre-treatment and post-treatment in treatment group had significant difference （281.86 ＋ 149.34 U vs 199.65 ± 127.09 U, 168.65± 102.04 μmol/L vs 94.13 ± 172.67 μmol/L, -1301.04 ± 662.78 U vs 892.23 ±861.41 U, 0.0198 ± 0.0128 vs 0.0089 ± 0.0228, all P 〈 0.05）. CONCLUSION： Adding glutamine to regular treatment can reverse the intestinal permeability, ameliorate the endotoxemia, promoting the curling process of liver cells. For patients with severe chronic hepatitis B, it is very important to find and reverse the intestinal permeability in time in clinical practice.