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World J Gastroenterol. Apr 21, 2007; 13(15): 2223-2228
Published online Apr 21, 2007. doi: 10.3748/wjg.v13.i15.2223
Glutamine and recombinant human growth hormone protect intestinal barrier function following portal hypertension surgery
Zhao-Feng Tang, Yun-Biao Ling, Nan Lin, Zheng Hao, Rui-Yun Xu
Zhao-Feng Tang, Yun-Biao Ling, Nan Lin, Zheng Hao, Rui-Yun Xu, Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong Provice, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Rui-Yun Xu, Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong Provice, China. xuruiyun@yahoo.com.cn
Telephone: +86-20-85516867-2154 Fax: +86-20-34305271
Received: December 29, 2006
Revised: February 5, 2007
Accepted: March 27, 2007
Published online: April 21, 2007
Abstract

AIM: 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-α 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-α 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.

CONCLUSION: 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.

Keywords: Liver cirrhosis, Portal hypertension, Total parenteral nutrition, Intestinal barrier function