L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis
L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis
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DOI：
10.1016/s0261-5614(03)00055-4
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发表时间：
2004-02-01
影响因子：
6.3
通讯作者：
Barrera-Zepeda, LM
中科院分区：
文献类型：
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作者：
Fuentes-Orozco, C;Anaya-Prado, R;Barrera-Zepeda, LM
背景和目标：成长。一些随机临床试验表明，谷氨酰胺（Gin）补充剂可能对选定的一组患者和条件有益。然而，富含谷氨酰胺的全肠外营养（TPN）对急性腹腔内感染恢复的影响尚未得到充分研究。因此，本研究的目的是调查是否提供谷氨酰胺富集TON后，手术和药物治疗的继发性腹膜炎提高感染发病率。方法：TKirty-three继发性腹膜炎患者被随机分配到接受标准（n = 16）TPN或L-丙氨酰-L-谷氨酰胺补充（n = 17）TPN，后医疗和手术治疗的感染病灶。两种TPN方案均为等氮和等热量，从术后第二天早晨开始，连续运行10天。对照组接受标准TPN，白色，治疗组给予L-丙氨酰-L-谷氨酰胺，0.40 g/kg/d（力肽，（R）Fresenius Kabi，Bad洪堡，德国）。感染性发病率，氮平衡，白细胞，淋巴细胞，亚群CD 4和CD 8，免疫球蛋白A（伊加），总数。对蛋白质、白蛋白、住院时间和重症监护室（ICU）住院时间以及死亡率进行评价。统计学分析包括单因素方差分析、非配对Student t检验、Mann-Whitney U检验、卡方检验或Fisher精确检验。氮平衡及血清白蛋白、伊加水平明显优于对照组。此外，在Gln治疗组中发现感染发病率显著降低。在比较各组时，观察到淋巴细胞计数以及亚群CD 4和CD 8和蛋白质显示出改善的倾向和死亡率降低的趋势。结论：补充L-丙氨酰-L-谷氨酰胺的TPN可改善继发性腹膜炎患者的感染发生率。胃肠外营养补充杜松子酒可能是一种替代增强宿主防御和改善感染发病率。(C)2003 Elsevier Ltd.保留所有权利。
Background & aims: A growing. number of randomized clinical trials suggest that glutamine (Gin) supplementation May be beneficial in a selected group of patients and conditions. However, the effects of Gln-enriched total parenteral nutrition (TPN) on recovery from acute intra-abdominal infection have not been thoroughly investigated. Therefore, the Aim of this study was to investigate whether the provision of Gln-enriched TON After surgical and medical treatment of secondary peritonitis improves infectious morbidity.Methods: TKirty-three patients with secondary peritonitis were randomly assigned to receive either standard (n = 16) TPN or L-alanyl-L-glutamine-supplemented (n = 17) TPN, after medical and surgical treatment of the infectious focus. The two TPN formulae were isonitrogenous and isocaloric, which commenced the morning after surgery and ran continuously for 10 consecutive days. The control group received standard TPN, white the treatment group was given L-alanyl-L-glutamine, 0.40 g/kg/d (Dipeptiven, (R) Fresenius Kabi, Bad Homburg, Germany). Infectious morbidity, nitrogen balance, leukocytes, Lymphocytes, subpopulations CD4 and CD8, Immunoglobulin A (IgA), total. proteins, albumin, hospital and intensive care unit (ICU) stays, and mortality were evaluated. Statistical analysis included one-way ANOVA, the unpaired Student's t-test, the Mann-Whitney U-test, chi(2) test, or Fisher's exact test.Results: Patients in both groups were comparable prior to the operation. Nitrogen balance and the levels of albumin and IgA were significantly better than those in the control group. Also, a significant reduction in the infectious morbidity was found in the Gln-treated group. Lymphocyte counts as well as subpopulations CD4 and CD8, and proteins showed a, propensity, to improvement and a tendency to reduced rates of mortality were observed when comparing the groups. Hospital and ICU stays were similar.Conclusion: L-alanyl-L-glutamine-supplemented TPN improved the infectious morbidity of patients with secondary peritonitis. Gin supplementation to parenteral nutrition may be an alternative for enhancing host defenses and improving infectious morbidity. (C) 2003 Elsevier Ltd. All rights reserved.