Effect Of Glutamine On Postoperative Serum IL-8, Serum VEGF And Serum HSP70 Levels In Patients With Gastric Carcinoma

Glutamine is the most abundant free amino acid in people's blood., The content of glutamine decreases obviously at the condition of wound, surgical intervention or infection. So it must be replenished exogenously and thus glutamine is a conditional necessary amino acid . As a immune nutrition , glutamine has been applied generally in clinic. It is protective for many kinds of serious patients. Such as sepsis, shock, surgical trauma and major operation, glutamine can augment the stress reaction in serious patients or the express of serum heat shock protein 70 (HSP70) in injured cells. Perhaps thus it protects organism. But now glutamine has been found that it can promote the growth of tumor cell in vitro study. The incidence rate of gastric carcinoma is high, surgical trauma is large, patients apply glutamine regularly after operation. In order to approach that whether glutamine can augment the possible risk to tumor patients. We compare alanyl-glutamine group (GLN group) with control group to observe levels and clinical significance of postoperative serum interleukin 8 (IL-8) ,serum vascular endothelial growth Factor (VEGF) and HSP70 after applying alanyl-glutamine to patients with gastric carcinoma.Method1. The collection of information and sampleFifty-five patients with gastric carcinoma from the general surgery department in the first affiliated hospital of Zhengzhou university joined this study during 2005.10-2006.10. But 5 patients had not completed the study. There were 41 men ,9 women and the mean age was 64.4±6.6. They were separated two groups randomly. One was GLN group(n=25) and the other was control group(n=25). To take suction venous blood 5ml from the two group patients preoperative 1d and postoperative 8d 7:00 separately and put 1ml into the EDTA anticoagulation pipe. Put 200ul plasma into EP pipe after centrifugalization and added 400ul acetonitrile in it, then centrifugalize the pipe with 15000r/min in 10 minutes and reserved in the -80℃refrigerator. The remnant blood was reserved in the -80℃refrigerator after blood serum was separated.2. The detection of blood plasma glutamineBlood plasma glutamine was detected by Agilent 1100 high performance liquid chromatogram (HPLC).3. The detection of IL-8, VEGF and HSP70Serum IL-8 and VEGF were detected by ELISA kit of ShangHai boatman company. Blood serum HSP70 was detected by ELISA kit of American R & D company.4. The determination of some nutrition indexesSerum albumin (AL) was determined by whole automatic biochemistry analyzer, body fat (BF) and body mass index (BMI )was measured by Omron body fat measure instrument.5. The record of clinical outcomesThe postoperative clinical outcomes of 2 group patients were observed and recorded. Including postoperative infection rate (PIR), the time of passage of gas by anus and the time of stay hospital.6. Data processingUse statistics soft ware SPSS13.0, normality test was applied to quantization data , normal distribution data were expressed by. Every indexes in the each groupwere compared by paired-samples T test, every in ( x±s ) dexes were compared by independent-samples T test and covariance analysis. Size of testα=0.05.Results1. The preoperative levels of plasma glutamine, serum IL-8,serum VEGF and serum HSP70 were compared with each other in the day1 between the two groupsTwo group patients were fully recovered and discharged. The preoperative levels of plasma glutamine, serum IL-8, serum VEGF and serum HSP70 were not statistically significant between the two groups (t: 0.94,1.71,1.04,0.67; P: 0.35, 0.25, 0.30, 0.50).2. The postoperative levels of plasma glutamine, serum IL-8, serum VEGF and serum HSP70 were compared with each other in the day 8between the two groupsLevel of plasma glutamine of GLN group increased significantly than that of cotrol group in postoperative (F=36.39, P=0.00).Level of serum IL-8 degraded significantly than that of control group in postoperative (F=10.12, P=0.03). Level of serum VEGF of GLN group was lower than control group, but had no statistically significant(F=0.13, P=0.72). To level of HSP70, GLN group increased notably than control group in postoperative (F=31.88, P=0.00).3. The comparison of preoperative and postoperative plasmaglutamine and serum HSP70 in the two groupsLevel of postoperative plasma glutamine in the day 1 was higher significant than level of preoperative in the GLN group (t=6.67, P=0.00) ,and there was statistically significant in the control group (t=2.95, P=0.01) . Level of serum HSP70 in preoperative was increased significantly than that in postoperative in the GLN group (t=7.20,P=0.00) , and so in the control group (t=2.31,P=0.30) .4. The comparison of preoperative and postoperative serum IL-8and serum HSP70 in the two groupsLevel of postoperative serum IL-8 was higher significantly than level of preoperative in the GLN group (t=2.30, P=0.03) , but there was no statistically significant in the control group (t=0.67, P=0.51) . Postoperative serum VEGF levels were lower than preoperative level in the GLN group (t=3.9,4 P=0.00) . and so in the control group (t=2.99, P=0. 01) .5. Serum AL, Body Fat and BMIPreoperative 1d serum AL levels, BF and BMI were compared with in the two groups and there were not statistical significances (t=0.94, P=0.35; t=1.71, P=0.25; t=1.04, P=0.30; t=0.67, P=0.50). Level of serum AL in the GLN group increased significantly than level in the control group in postoperative 8d(F=65.54,P=0.00).Level of serum AL was compared with each other between preoperative 1d and postoperative 8d in the GLN group and there was no difference(t=1.79,P=0.09) ,however, there was obviously difference in the control group(t=8.78, P=0.00). Data of Body Fat in the GLN group was higher significantly than data of BF in the control in postoperative 8d (F=8.67,P=0.01) and there was no obviously difference between preoperative 1d and postoperative 8d (t=0.02,P=0.99) in the GLN group and so in the control group (t=1.77,P=0.09) . BMI in the GLN group was higher significantly than that in control group in postoperative 8d(F=52.30,P=0.00). BMI of postoperative was lower than that of preoperative but was no statistical significant in the GLN group (t=1.21 ,P=0.24 ), nevertheless, BMI of postoperative was degraded obviously and there was statistical significant(t=8.57,P=0.00) . 7. The comparison of clinical outcomes between the two groupsThe time of passage of gas by anus and stay hospital in GLN group was obviously shorter than that of control group (P=0.01 and P=0.00) . The rate of postoperative infected rate in GLN group was lower than the control group but was not statistically significant (x~2=1.18, P=0.277) .Conclusion1. The postoperation gastric carcinoma patients were supplied with glutamine can improve their nutritional states, reduce their postoperative infected rate and promote their clinical recovery.2. The mechanisms that glutamine can improve patients recovery perhaps was to promote organism HSP70 secreted when the gastric carcinoma patients were supplied glutamine through the vein.3. Supplying glutamine to gastric carcinoma patients did not obviously raise the level of serum IL-8 and VEGF but serum IL-8 level was obviously lower which indicated that supplying glutamine to postoperative gastric carcinoma patients scarcely promote the tumor cells growth or generation, however, it is able to improve clinical nutritional status and promote the clinical recovery .4. To patients with gastric carcinoma, glutamine is a safe nutritional support substance.