L-Alanyl-Glutamine Preoperative Infusion in Patients with Critical Limb Ischemia Subjected to Distal Revascularization Reduces Tissue Damage and Protects from Oxidative Stress
L-Alanyl-Glutamine Preoperative Infusion in Patients with Critical Limb Ischemia Subjected to Distal Revascularization Reduces Tissue Damage and Protects from Oxidative Stress
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DOI：
10.1016/j.avsg.2010.01.005
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发表时间：
2010-05-01
影响因子：
1.5
通讯作者：
de Vasconcelos, Paulo Roberto Leitao
中科院分区：
文献类型：
--
作者：
Alves, Wellington Forte;Aguiar, Erika Elisa;de Vasconcelos, Paulo Roberto Leitao
背景：严重肢体缺血(CLI)是肢体血流不足的最严重的外周血管疾病。目的：观察术前输注L丙氨酰-谷氨酰胺(L-丙氨酰-谷氨酰胺)对股远端动脉旁路手术患者缺血期及血液复流后前30min的影响。术前3小时内静脉滴注生理盐水(1000毫升)或L-丙氨酸-谷氨酰胺250毫升加生理盐水750毫升。分别在手术开始时、缺血结束时、再灌注后15分钟和30分钟采集肌肉和血液标本。结果：L-丙氨酸-谷氨酰胺诱导的肌肉谷胱甘肽浓度升高，硫代巴比妥酸活性物质浓度降低，抗氧化能力增强，抗脂质过氧化作用增强。L-丙氨酸-谷氨酰胺治疗患者的乳酸脱氢酶、乳酸和葡萄糖血液浓度的降低表明肌肉和外周组织对葡萄糖的利用增加。肌酸磷酸激酶血药浓度的降低可能反映了L-丙氨酸-谷氨酰胺治疗后肌细胞损伤的减轻。结论：L-丙氨酸-谷氨酸预处理可减轻慢性阻塞性肺损伤患者的肌细胞损伤，提高抗氧化能力。
Background: Critical limb ischemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb. Our aim was to examine the effects of preoperative infusion of L-alanyl-glutamine (L-Ala-Gln) during the ischemic period and during the first 30 minutes following blood reflow in patients with CLI who are undergoing distal femoral artery bypass surgery.Methods: Thirty-two patients with CLI were alternately allocated to group 1 (saline) or group 2 (L-Ala-Gln). Saline (1000 mL) or L-Ala-Gln 250 mL plus 750 mL of saline were infused intravenously over a 3-hour period prior to surgery. Samples (muscle and blood) were collected at the beginning of the surgical procedure, at the end of ischemia, and at 15 and 30 minutes after reperfusion.Results: L-Ala-Gln induced elevation in glutathione (GSH) muscle concentrations while promoting reduction in thiobarbituric acid reactive substance concentrations, demonstrating enhancement of antioxidant capacity and protection from lipid peroxidation. Decreases in LDH, lactate, and glucose blood concentrations in L-Ala-Gln-treated patients suggest increased glucose utilization by muscle and peripheral tissues. Reduction in creatine phosphokinase blood concentrations may reflect smaller muscle cell damage in L-Ala-Gln-treated patients.Conclusion: L-Ala-Gln pretreatment reduces muscle cell damage and enhances antioxidant capacity in patients with CLI.