Influence of alanyl-glutamine-enriched enteral nutrition on intestinal permeability of patients with abdominal surgical stress response

Abstract

Objective To investigate the influence of alanyl-glutamine-enriched enteral nutrition on the intestinal permeability in patients with abdominal surgical stress response.Methods A total of 216 patients undergoing abdominal surgery were randomly divided into three groups,namely,the conventional alanyl-glutamine-enriched enteral nutrition(GLN group),enteral nutrition(EN group) and parenteral nutrition(PN group).The three groups were given isonitrogenic(0.2 g· kg-1·d-1) and isocarloric(125.4 kJ·kg-1·d-1) support during 3-11 days after operation.The urinary lactulose/mannitol(L/M) ratios were observed 6 h after the patients were given 10 g lactulose and 5 g mannitol on one day before and the 7th,12th day after operation.High pressure liquid chromatography was used to determine the urinary levels of lactulose and mannitol.Results The mannitol levels had no significant change before and 7,12 days after operation in the 3 groups,and there were also no significant difference between the 3 groups before and 7,12 days after operation.The L/M values before and 7,12 days after operation were 0.025±0.009,0.038±0.017,and 0.028±0.012 in GLN group,0.024±0.011,0.061±0.019,and 0.027±0.014 in EN group,and 0.026±0.012,0.083±0.021,and 0.047±0.013 in PN group,respectively.Statistical analysis showed that the L/M ratios in the 3 groups were all significantly increased 7 days after operation compared with those before operation(P0.05),and that of PN group was significantly higher than those of EN group and GLN group(P0.05),and that of EN group was significantly higher than that of GLN group(P0.05).Twelve days after operation,the L/M ratios in PN group was still significantly higher than that before operation and those in the EN and GLN groups(P0.05),and that in EN group was similar to that before operation and that in GLN group.Conclusion The intestinal permeability is greatly increased during the early period after operation.Enteral nutrition is favorable for maintaining the function of intestinal mucosal barrier.Alanyl-glutamine-enriched enteral nutrition can improve the function of intestinal mucosal barrier.