丙氨酰谷氨酰胺对重型颅脑损伤患者肠黏膜通透性及血浆二胺氧化酶水平的影响

Effect of Alanyl Glutamine on Intestinal Mucosa Permeability and Plasma Diamine Oxidase in Patients with Severe Brain Injury

目的探讨丙氨酰谷氨酰胺对重型颅脑损伤患者肠黏膜通透性及血浆二胺氧化酶水平的影响。方法选取我科2011年9月—2013年4月收治的重型颅脑损伤患者100例,采用随机数字表法分为对照组和观察组,每组50例。对照组患者在综合治疗的基础上给予单纯静脉营养,观察组患者在静脉营养基础上给予丙氨酰谷氨酰胺0.4g·kg-1·d-1,输液泵24 h匀速输注。观察两组患者治疗第1、5、9天尿中乳果糖排泄率及血浆二胺氧化酶水平。结果对照组患者第1、5、9天尿中乳果糖排泄率分别为(0.46±0.10)%、(0.38±0.14)%、(0.30±0.05)%,血浆二胺氧化酶水平分别为(3.79±1.12)U/ml、(3.63±0.81)U/ml、(2.98±1.83)U/ml;观察组第1、5、9天尿中乳果糖排泄率分别为(0.40±0.80)%、(0.24±0.25)%、(0.18±0.40)%,血浆二胺氧化酶水平分别为(3.28±1.05)U/ml、(2.89±1.17)U/ml、(1.56±1.12)U/ml。两组患者治疗第1天尿中乳果糖排泄率、血浆二胺氧化酶水平比较,差异均无统计学意义(P>0.05);观察组患者治疗第5、9天尿中乳果糖排泄率、血浆二胺氧化酶水平均低于对照组(P<0.05)。结论丙氨酰谷氨酰胺强化的肠外营养有助于降低重型颅脑损伤患者肠黏膜通透性,保护患者肠黏膜屏障功能。

Objective To investigate the impact of alanyl glutamine on intestinal mucosa permeability and plasma di- amine oxidase in patients with severe brain injury （SBI）. Methods A total of 100 SBI patients admitted to this hospital from September 2011 to April 2013 were divided randomly into groups study, control, 50 in each. Control group were given only in- travenous nutrition on the basis of comprehensive treatment, study group given additional alanyl glutamine, 0. 4 g ·kg^-1·d^-1, 24 h infusion at constanf speed. The urinary lactulose excretion rate and plasma diamine oxidase level were observed in 2 groups on days 1, 5, 9 of treatment. Results On days 1, 5, 9, the urinary lactulose excretion rates were （ 0. 46 ± 0. 10 ） %, （0. 38 ±0. 14）%, （0. 30 ±0.05）%, respectively, in control group, and （0.40 ±0. 80）%, （0. 24 ±0. 25）%, （0. 18 ±0.40）%, respectively, in study group ; thediamineoxidaselevel （3.79±1.12） U/ml, （3.63±0.81） U/ml, （2.98 ± 1.83） U/ml, respectively, in control group, and （3.28 ± 1.05） U/ml, （2. 89 ± 1.17） U/ml, （1.56 ± 1.12） U/ml, respectively, in study group. No significant difference was noted in urinary lactulose excretion rate, plasma diamine oxidase lev- el between 2 groups on day 1 of treatment （P 〉 0.05 ）. Urinary lactulose excretion rate and plasma diamine oxidase were lower in study group than in control group on days 5, 9 of treatment （ P 〈 0. 05 ）. Conclusion Ananyl glutamine - enhanced parenteral nutrition helps reduce intestinal mucosa permeability and protect intestinal barrier function in SBI patients.