Protective Effect Of Glutamine On Intestinal Mucosal Barrier And Liver Function In Patients With Cirrhosis

Background:Hepatic cirrhosis is a common and frequently-occurring disease in digestive system. Because of its generally irreversible once it occurs, the treatment is generally focused on preventing progression and complications. Reported in the relevant literature, about 50% of hepatic cirrhosis patients with liver failure died of bacterial infection, and the main pathogens is gram-negative enteric bacteria. During the cirrhosis, the intestinal mucosal barrier is damaged which provoke permeability increasing and the intestinal bacteria and endotoxin entering into systemic circulation. This is the main reason that triggered intestinal infection, hepatic encephalopathy and liver failure, so how to effectively protect the intestinal barrier and deter the development of cirrhosis become an urgent problem needed to be solved. As a non-essential amino acid, glutamine has been widely used in clinical, it has an important role in the maintenance of intestinal structure and function which could promote intestinal immune function and so on. By now its influence in the hepatic cirrhosis caused by intestinal endotoxemia were confirmed by much of animal experiments, but not in cirrhotic patients.Objective:To investigate the effect of glutamine(GLN)on intestinal barrier and liver function of hepatic cirrhosis patients.Methods:Forty patients with hepatic cirrhosis were randomly allocated into two groups:experimental group and control group.The patients in experiment group received oral administration of glutamine based on conventional treatment,while the patients in control group received conventional treatment only.The levels of blood endotoxin,diamine oxidase(DAO),tumor necrosis factor-α(TNF-α),urinary lactulose/mannitol (L/M) ratio,glutathione(GSH) and alanine aminotransferase (ALT) were determined before and after treatment for six weeks.Results :1. After six weeks treatment,the endotoxin in experimental group was lower than that before treatment (P <0. 05),but there was no significant difference in control group(P >0. 05).The contents of DAO and L/M were lower than that before treatment (P <0. 05) both in experimental and control group. Glutamine treatment had significant effect on change of serum endotoxin, DAO, L / M, TNF-αlevels ( P <0. 01).2. The GSH level in both groups increased after six weeks (P <0. 05), and the contents of ALT was lower.Glutamine treatment had significantly effect on levels of GSH(P<0.01),but not of ALT ( P >0. 05).3. The contents of ammonia had no significant changes in control and experimental group before and after treatment(P >0.05).Conclusion:1. Oral administration of Glutamine could effectively maintain intestinal barrier by reducing the endotoxemia and lowing the blood DAO, TNF-αand urine L/M in patients with cirrhosis.2. Glutamine can increase GSH reserve in hepatic cirrhosis patients and reduce ALT level,so it has obviously protection of liver function.3. Oral glutamine in hepatic cirrhosis patients (child-pugh classification A and B) had no obvious influences on plasma ammonia.