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Randomized Controlled Trial
. 2007 Apr 21;13(15):2223-8.
doi: 10.3748/wjg.v13.i15.2223.

Glutamine and recombinant human growth hormone protect intestinal barrier function following portal hypertension surgery

Zhao-Feng Tang  1 , Yun-Biao Ling, Nan Lin, Zheng Hao, Rui-Yun Xu
Affiliations
Randomized Controlled Trial

Glutamine and recombinant human growth hormone protect intestinal barrier function following portal hypertension surgery

Zhao-Feng Tang et al. World J Gastroenterol. .

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-alpha 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-alpha 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.

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Figures

Figure 1
Figure 1
PCNA expression of intestinal mucosa. Brown nuclei are seen in PCNA positive cells. (DAB, × 400). A: Preoperative; B: Control, postoperative; C: Supplemental, postoperative.
See this image and copyright information in PMC

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