The Influence Of Intravenous N(2)-L-alanyl-L-gluta-mine On Insulin Resistance After Gastrointestinal Surgery

Objective: To investigate the effects of intravenous N(2)-L-alanyl-L-glutamine on perioperative insulin resistance in gastrointestinal surgery and its possible mechanism.Methods: 60 cases of elective gastrointestinal tumor patients without diabetic,aged from35 to 75 years old,male or female,body mass index(BMI)from 18.5 to 25 kg/m2,ASA I~II,were allocated to two groups(n=30,each)randomly: patients in glutamine(Gln)group were received L-alanyl-L-glutamine(0.4 g/kg BW/day,diluted with amino acids of five-folds volume)one hour before surgery and on 1 days and 2 days after operation.Controls(C group)were given amino acids only by intravenous injection at the same time.Venou blood samples were collected on 1 hour before anesthesia(T1),after anesthesia(T2),end of operation(T3)and the 1st(T4),3rd(T5),7th(T6)of the postoperative day to measure serum concentration of glucose,insulin,glucagon,cortisol,reactive oxygen species,tumor necrosis factor-?,and plasma concentration of Glutathione,oxidized glutathione and total antioxidant capacity,and calculation of insulin resistant index and insulin sensitivity index.Cardiovascular complication(arrhythmia,acute myocardial infarction and congestive heart failure),pulmonary complication(pneumonia and respiratory fuction insufficiency),infectious complication(Wound infection,Peritonitis,anastomotic leak,Sepsis and Urinary tract infection),and gastrointestinal fuction(the first time of exhaust and bowel obstruction)were recorded on days 1,3and 7after surgery.Results: 1.There were no significantly differences of BMI,gender,age,duration of operation,blood loss,total volume fluid and postoperative vision analog score in both groups.(P>0.05)2.Compared with the baseline level(T1),The Values of BG,INS,HOMA-IR,ROS and GSSG were increased apparently and the values of ISI were declined at T2~5 in controls(P<0.05),which were found changed only at T3 in group G(P<0.05),and decresed apparently(P<0.05)at T2~5 comparing to group C.The Values of IRG and Cor were increased remarkable at T2 to T5 in both groups(P<0.05),and there were no distinct differences between the two groups(P>0.05).A substantial increase in the TNF-? values were observed at T3~5 in controls(P<0.05),which were incresed only at T3~4 in group G(P<0.05),and mark lower at T3~5 than that in group C(P<0.05).And a substantial decrease in controls in the GSH/GSSG and T-AOC data at T2~5,and GSH data at T3~5were observed(P<0.05).There were no significantly differences of GSH,GSH/GSSG and T-AOC at any time in group G(P>0.05).3.The first time of exhaust and the incidence of incision infection in group G were lower than that in group C substantially(P < 0.05).And there were no obvious differences of the incidence of arrhythmia,pneumonia,urinary tract infection or anastomotic leak in both groups(P>0.05).Conclusions: 1.Patients receiving Gln dipeptide revealed the dgree and duration of perioperative insunlin resistance is ameliorative.2.The less complications are found in patients who have received Gln dipeptide,which could promote postoperative recovery.3.Ameliorative insulin resistance and postoperative recovery are found in patients who have received Gln dipeptide,which may be assosiated with raised antioxidation capacity.