AIM To investigate the individual and thecombined effects of glutamine, dietary fiber,and growth hormone on the structural adaptationof the remnant small bowel.METHODS Forty-two adult male Sprague-Dawley rats underwen...AIM To investigate the individual and thecombined effects of glutamine, dietary fiber,and growth hormone on the structural adaptationof the remnant small bowel.METHODS Forty-two adult male Sprague-Dawley rats underwent 85% mid-small bowel( TPN ) support during the first threepostoperational days. From the 4thpostoperational day, animals were randomlyassigned to receive 7 different treatments for 8days: TPNcon group, receiving TPN and enteral20 g.L- 1 glycine perfusion; TPN + Gin group,receiving TPN and enteral 20 g.L-1 glutamineperfusion; ENcon group, receiving enteralnutrition (EN) fortified with 20 g@L-1 glycine; EN+ Gin group, enteral nutrition fortified with20g. L-1 glutamine; EN + Fib group, enteralnutrition and 2 g. d- 1 oral soybean fiber; EN + GHgroup, enteral nutrition and subcutaneousgrowth hormone (GH) (0.31U) injection twicedaily; and ENint group, glutamine-enriched EN.oral soybean fiber, and subcutaneous GHinjection.RESULTS Enteral glutamine perfusion duringTPN increased the small intestinal villus height(jejunal villus height 250 μm ±29 μm in TPNconvs 330 μm ± 54 μm in TPN + Gin, ileal villus height260μm±28μm in TPNcon vs 330 μm±22μm inTPN + Gin, P＜0.05) and mucosa thickness( jejunal mucosa thickness 360 μm ± 32 μm inTPNcon vs 460 μm ± 65 μm in TPN + Gin, ilealmucosa thickness 400 μm ± 25 μm in TPNcon vs490μm ± 11 μm in TPN + Gin, P＜0.05) incomparison with the TPNcon group. Either fibersupplementation or GH administration improvedbody mass gain (end body weight 270 g ± 3.6 g inEN+Fib, 265.7 g ± 3.3 g in EN+GH, vs 257g±3.3g in ENcon, P＜0.05), elevated plasmainsulin-like growth factor ( IGF-Ⅰ ) level(880 μg. L-1 ± 52 μg. L-1 in EN + Fib, 1200 μg. L-1± 96 μg. L- 1 in EN ± GH, vs 620 μg. L-1 ±43 μg. L-1 in ENcon, P＜0.05), and increased thevillus height (jejunum 560 μm ± 44 μm in EN ± Fib,530 μm± 30 μm in EN ± GH, vs 450 μm ± 44 μm inENcon, ileum 400 μm ± 30 μm in EN + Fib, 380 μm±49 μm in EN± GH, vs 320 μm± 16 μm in ENcon,P＜0.05) and the mucosa thickness (jejunum740 μm ± 66 μm in EN ± Fib, 705 μm ± 27 μm in EN ±GH, vs 608 μm ± 58 μm in ENcon, ileum 570 μm ±27 μm in EN ± Fib, 560 μm ± 56 μm in EN ± GH, vs480μm ± 40 μm in ENcon, P＜0.05) in remnantjejunum and ileum. Glutamine-enriched ENproduced little effect in body mass, plasma IGF-Ⅰ level, and remnant small bowel mucosalstructure. The ENint group had greater bodymass (280g ± 2.2g), plasma IGF-Ⅰ level(1450g@L-1 ± 137g. L 1), and villus height(jejunum 620 μm ± 56 μm, ileum 450 um ± 31 μm)and mucosal thickness (jejunum 800 μm ± 52 μm,ileum 633 μm± 33 μm) than those in ENcon, EN +Gin (jejunum villus height and mucosa thickness450 μm ± 47 μm and 610 μm ± 63 μm, ileum villusheight and mucosa thickness 330 μm ± 39 μm and500 μm± 52 μm), EN + GH groups (P＜0.05), andthan those in EN + Fib group although nostatistical significance was attained.CONCLUSION Both dietary fiber and GH whenused separately can enhance the postresectionalsmall bowel structural adaptation. Simultaneoususe of these two gut-trophic factors can producesynergistic effects on small bowel structuraladaptation. Enteral glutamine perfusion isbeneficial in preserving small bowel mucosalstructure during TPN, but has little beneficialeffect during EN.展开更多
基金Supported partially by the MedicalHealth Research Foundation of PLA, No. 980015
文摘AIM To investigate the individual and thecombined effects of glutamine, dietary fiber,and growth hormone on the structural adaptationof the remnant small bowel.METHODS Forty-two adult male Sprague-Dawley rats underwent 85% mid-small bowel( TPN ) support during the first threepostoperational days. From the 4thpostoperational day, animals were randomlyassigned to receive 7 different treatments for 8days: TPNcon group, receiving TPN and enteral20 g.L- 1 glycine perfusion; TPN + Gin group,receiving TPN and enteral 20 g.L-1 glutamineperfusion; ENcon group, receiving enteralnutrition (EN) fortified with 20 g@L-1 glycine; EN+ Gin group, enteral nutrition fortified with20g. L-1 glutamine; EN + Fib group, enteralnutrition and 2 g. d- 1 oral soybean fiber; EN + GHgroup, enteral nutrition and subcutaneousgrowth hormone (GH) (0.31U) injection twicedaily; and ENint group, glutamine-enriched EN.oral soybean fiber, and subcutaneous GHinjection.RESULTS Enteral glutamine perfusion duringTPN increased the small intestinal villus height(jejunal villus height 250 μm ±29 μm in TPNconvs 330 μm ± 54 μm in TPN + Gin, ileal villus height260μm±28μm in TPNcon vs 330 μm±22μm inTPN + Gin, P＜0.05) and mucosa thickness( jejunal mucosa thickness 360 μm ± 32 μm inTPNcon vs 460 μm ± 65 μm in TPN + Gin, ilealmucosa thickness 400 μm ± 25 μm in TPNcon vs490μm ± 11 μm in TPN + Gin, P＜0.05) incomparison with the TPNcon group. Either fibersupplementation or GH administration improvedbody mass gain (end body weight 270 g ± 3.6 g inEN+Fib, 265.7 g ± 3.3 g in EN+GH, vs 257g±3.3g in ENcon, P＜0.05), elevated plasmainsulin-like growth factor ( IGF-Ⅰ ) level(880 μg. L-1 ± 52 μg. L-1 in EN + Fib, 1200 μg. L-1± 96 μg. L- 1 in EN ± GH, vs 620 μg. L-1 ±43 μg. L-1 in ENcon, P＜0.05), and increased thevillus height (jejunum 560 μm ± 44 μm in EN ± Fib,530 μm± 30 μm in EN ± GH, vs 450 μm ± 44 μm inENcon, ileum 400 μm ± 30 μm in EN + Fib, 380 μm±49 μm in EN± GH, vs 320 μm± 16 μm in ENcon,P＜0.05) and the mucosa thickness (jejunum740 μm ± 66 μm in EN ± Fib, 705 μm ± 27 μm in EN ±GH, vs 608 μm ± 58 μm in ENcon, ileum 570 μm ±27 μm in EN ± Fib, 560 μm ± 56 μm in EN ± GH, vs480μm ± 40 μm in ENcon, P＜0.05) in remnantjejunum and ileum. Glutamine-enriched ENproduced little effect in body mass, plasma IGF-Ⅰ level, and remnant small bowel mucosalstructure. The ENint group had greater bodymass (280g ± 2.2g), plasma IGF-Ⅰ level(1450g@L-1 ± 137g. L 1), and villus height(jejunum 620 μm ± 56 μm, ileum 450 um ± 31 μm)and mucosal thickness (jejunum 800 μm ± 52 μm,ileum 633 μm± 33 μm) than those in ENcon, EN +Gin (jejunum villus height and mucosa thickness450 μm ± 47 μm and 610 μm ± 63 μm, ileum villusheight and mucosa thickness 330 μm ± 39 μm and500 μm± 52 μm), EN + GH groups (P＜0.05), andthan those in EN + Fib group although nostatistical significance was attained.CONCLUSION Both dietary fiber and GH whenused separately can enhance the postresectionalsmall bowel structural adaptation. Simultaneoususe of these two gut-trophic factors can producesynergistic effects on small bowel structuraladaptation. Enteral glutamine perfusion isbeneficial in preserving small bowel mucosalstructure during TPN, but has little beneficialeffect during EN.
