Protact Effect Of Glutamine On Intestinal Mucosal Barrier And Immune Function In Patients With Hepatic Cirrhosis

Objective: Currently considered,intestine is not only the important organof digestion and absorption, but also the largest immune organ. Intestinalmucosa can monitor and clear the intestinal bacteria, toxins, food antigens andpotential harmful biological peptide, ensuring the integrity of the body andconstituting the intestinal mucosal barrier. Hepatic cirrhosis is a commonchronic liver disease characterized by diffuse fibrosis with liver tissue, falseflocculus and regeneration nodules. With Cirrhosis, the long-term existence ofportal hypertension and impaired liver cell function make patients experiencedmany questions, such as gastrointestinal congestion, the decrease in thesynthesis and secretion of digestive enzymes and bile, varying degrees ofmalnutrition, the increasing synthesis of cytokine,systemic and local immunedysfunction, intestinal bacterial overgrowth, dysbacteriosis, and so on,resulting in the change of intestinal mucosal permeability and intestinal barrierdysfunction. The change of immune system also has the extremely importantpathophysiological significance in the process of liver cirrhosis formation anddevelopmentStudies shows that, with cirrhosis, the phagocytic function ofliver Kupffer cell reduces, the complement generates not enough, the numberand function of T lymphocyte decline, the body's systemic and local immunefunction are damaged. The intestinal mucosal barrier dysfunction and impairedimmune function result in bacterial translocation and endotoxemia, thenfurther aggravate harm to the liver function and intestinal mucosal barrier, it isclosely related to the happening mechanism of severe complications ofcirrhosis, such as spontaneous bacterial peritonitis and hepatic encephalopathy.Many literature indicates,the vicious circle between the intestinal mucosalbarrier dysfunction-intestinal bacterial translocation and/or enterogenous ~endotoxemia-progression is an important pathophysiological mechanism ofliver disease in patients with exacerbations.Glutamine is the most abundant amino acid in the body cells, it has beenwidely used in clinical and confirmed by a large number of animalexperiments in promoting intestinal mucosal epithelial repair, regulating thesystemic and intestinal immune,preventing intestinal bacterial translocation,reducing the level of endotoxin,inproving the status of nutritional, correctingthe hypoalbuminemia and protecting liver cell. This experiment was aimed toinvestigating the protective effect of alanyl glutamine intestinal mucosalbarrier and immune function in patients with hepatic cirrhosis.Methods: Collect40cases diagnosed in patients with hepatic cirrhosis atthe inpatient department of gastroenterology in Hebei Province People'sHospital(in accordance with the Society of infectious and parasitic diseases,the Chinese Society of Hepatology, CMA in september2000revised diagnosiscriteria), aged20to75.40cases with cirrhosis were randomly divided into two groups. Thepatients in A group received conventional treatment only, the patients in Bgroup received alanyl glutamine reagent intravenous infusion base onconventional treatment, the control group concluds16healthy blood donors.The levels of peripheral blood T lymphocyte group (CD3~+, CD4~+, CD8~+,CD4~+/CD8~+), Serum immunoglobulin (IgA, IgG, IgM), plasmaendotoxin,diamine oxidase(DAO), tumor necrosis factor-α (TNF-α), theD-lactate were determined between the two groups before and after thetreatment for2-week.ALL date was analyzed by SPSS version13.0for Windows software.Results:1The levels of peripheral blood CD3+, CD4+, CD8+T lymphocyte in cirrhosispatients is lower than the control group, serum IgA, IgG and plasma the DAO,D-lactic in cirrhosis patients is higher than the control group (P<0.01).2Changes of the demography and peripheral blood T lymphocytes indexes oftwo group: age, sex, body weight and liver function Child-pugh classification were similar in two groups (P>0.05), they were comparable.After two-week treatment, the CD3~+, CD4~+and CD8~+T lymphocyte in Bgroup were higher than that befor treatment (P<0.05). The level ofCD4~+/CD8~+in previous treatment was similar with this in later treatment of Bgroup. There were no significant differences in above-mentioned indexesbetween the treatment of A group from start to finish. The levels of the CD3~+and CD4~+lymphocyte had significant difference between the A and B group(P<0.05).3Changes of serum immunoglobulin levels of two groups: Compared with2weeks ago, the level of serum IgA increased significantly after the treatment ofB group (P<0.01). While there were no significant differences in serun IgAlevel before and after treatment of the A group (P>0.05). The levels of IgMand IgG had no significant change in A and B group before and after treatment(P>0.05). The levels of the serum IgA had significant difference between the Aand B group (P<0.05).4Changes of plasma DAO, D-lactate and TNF-α levels of two group: Thelevels of plasma DAO, D-lactate and TNF-α had no significant change in Aand B group before and after treatment,the same as between A group and Bgroup(P>0.05).Conclusion:1The levels of peripheral blood CD3~+, CD4~+, CD8~+T lymphocyte in cirrhosispatients is lower than the control, serum IgA, IgG and plasma the DAO,D-lactic in cirrhosis patients is higher than the control, immune dysfunctionand intestinal mucosal barrier dysfunction are found in cirrhosis patients.2Intravenous glutamine could contribute to improve immune function byincreasing the levels of peripheral blood CD3~+, CD4~+, CD8~+T lymphocyte andserum IgA in patients with cirrhosis.3Short-term(two-week) of intravenous glutamine in hepatic cirrhosis had noobvious influences on intestinal mucosal barrier.