The Clinical Effects of Exogenous Glutamine on Sepsis Patients with Hypoalbuminemia_West China Medical Journal

Authors：

 QIWei , HUANGFei , SUNZhong-yan , SUNBao-di , SUNZhao-rui , LINJin-feng ,  NIEShi-nan

Department of Emergency, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu 210002, P. R. China;

Corresponding?author：

NIEShi-nan, Email: shn_nie@sina.com

Keywords：

Glutamine; Enteral nutrition; Sepsis; Hypoproteinemia

DOI：

10.7507/1002-0179.20140308

Video：

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Objective To explore the clinical effects of exogenous glutamine on patients suffering from sepsis with hypoalbuminemia in emergency department. Methods Eighty-six patients with sepsis and hypoalbuminemia enrolled from January to November 2013 in the Emergency Department of our hospital were randomly divided into treatment group and control group. Forty-three patients in the control group were given conventional treatments, while the other 43 in the treatment group were treated with glutamine therapy based on the conventional treatments. The clinical efficacy of the two groups including inflammatory markers, albumin level, APACHEⅡ score and SAPSⅡ score, mortality, length of hospital stay were analyzed on day 7, 14, and 28 after being enrolled. A comprehensive analysis of the clinical effects in these two groups was performed. Results Eighty-six cases were enrolled in this study. The mortality on day 14 and 28 in the treatment group was significantly lower than that in the control group (P<0.05). Inflammatory markers (WBC count, CRP concentration, and PCT concentration) in patients of the treatment group were gradually decreased, whereas serum albumin levels were gradually increased compared with the control group (P<0.05). The cure rate of patients in the treatment group was significantly higher than that in the control group, while the average length of stay was shorter than the control group (P<0.05) on day 28. Conclusion Exogenous glutamine supplementation can improve patient cure rates and reduce hospital stays which has good clinical effects on patients with sepsis and hypoalbuminemia in emergency department.

Citation： QIWei, HUANGFei, SUNZhong-yan, SUNBao-di, SUNZhao-rui, LINJin-feng, NIEShi-nan. The Clinical Effects of Exogenous Glutamine on Sepsis Patients with Hypoalbuminemia. West China Medical Journal, 2014, 29(6): 1007-1010. doi: 10.7507/1002-0179.20140308 Copy

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12.	任巧. 谷氨酰胺對膿毒癥患者胃腸道黏膜的保護作用研究[J]. 臨床醫學, 2013, 33(9): 72-73.
13.	崔巍, 孫翠明, 劉沛. 谷氨酰胺對腸粘膜上皮細胞合成多聚免疫球蛋白受體的影響[J] 陜西醫學雜志, 2011, 40(11):1452-1454.
14.	Han T, Li XL, Cai DL, et al. Effects of glutamine-supplemented enteral or parenteral nutrition on apoptosis of intestinal mucosal cells in rats with severe acute pancreatitis[J]. Eur Rev Med Pharmacol Sci, 2013, 17(11): 1529-1535.
15.	周濟宏, 李幼生, 洪志堅, 等. 腫瘤壞死因子對谷氨酰胺促大鼠小腸蛋白質合成的影響及途徑[J]. 醫學研究生學報, 2013, 26(12): 1244-1249.
16.	李明泉, 舒磊, 王曉霞, 等. 谷氨酰胺強化治療對危重癥病人臨床結局影響的系統性研究[J]. 腸外與腸內營養, 2014, 21(2): 101-105.
17.	Cruzat VF, Bittencourt A, Scomazzon SP, et al. Oral free and dipeptide forms of glutamine supplementation attenuate oxidative stress and inflammation induced by endotoxemia[J]. Nutrition, 2014, 30(5): 602-611.
18.	胡秀英, 許春芳, 王超, 等. 含谷氨酰胺的腸外營養對急性胰腺炎患者預后影響的Meta分析[J]. 現代生物醫學進展, 2013, 13(22): 4302-430.

1. 馬曉春, 孫旖旎. 危重癥患者輸注白蛋白的利與弊[J]. 中華內科雜志, 2012, 51(11): 845-847.
2. 胡志華, 陳勉, 陳偉. 谷氨酰胺強化的腸內營養對膿毒癥患者免疫功能的影響[J]. 中國熱帶醫學, 2012, 12(6): 722-724.
3. Cavalcante AA, Campelo MW, De Vasconcelos MP, et al. Enteral nutrition supplemented with l-glutamine in patients with systemic inflammatory response syndrome due to pulmonary infection[J]. Nutrition, 2012, 28(4): 397-402.
4. 王玉, 張泓. 靜脈谷氨酰胺雙肽強化的腸內營養對膿毒癥患者臨床指標的影響[J]. 安徽醫科大學學報, 2012, 47(11): 1333-1336.
5. Brinson RR, Kolts BE. Diarrhea associated with severe hypoalbuminemia: a comparison of a peptide-based chemically defined diet and standard enteral alimentation[J]. Crit Care Med, 1988, 16(2): 130-136.
6. 徐芳. 腸內營養支持相關腹瀉影響因素分析[J]. 中國現代醫生, 2012, 50(16): 49-50.
7. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference[J]. Intensive Care Med, 2003, 29(4): 530-538.
8. 習豐產, 耿艷霞, 虞文魁, 等. 腸內營養對長期禁食危重癥病人炎性反應和細胞免疫的影響[J]. 腸外與腸內營養, 2013, 20(4): 212-215.
9. Hohn A, Schroeder S, Gehrt A, et al. Procalcitonin-guided algorithm to reduce length of antibiotic therapy in patients with severe sepsis and septic shock[J]. BMC Infect Dis, 2013, 13(1): 158.
10. 景炳文, 林兆奮. 關于毛細血管滲漏綜合征救治中有關問題的討論[J]. 中國危重病急救醫學, 2009, 21(12): 705, 后插4.
11. 范江花, 祝益民, 張新萍. 膿毒癥患兒低蛋白血癥與CRP及PCT的相關性[J]. 中國當代兒科雜志, 2010, 12(11): 870-873.
12. 任巧. 谷氨酰胺對膿毒癥患者胃腸道黏膜的保護作用研究[J]. 臨床醫學, 2013, 33(9): 72-73.
13. 崔巍, 孫翠明, 劉沛. 谷氨酰胺對腸粘膜上皮細胞合成多聚免疫球蛋白受體的影響[J] 陜西醫學雜志, 2011, 40(11):1452-1454.
14. Han T, Li XL, Cai DL, et al. Effects of glutamine-supplemented enteral or parenteral nutrition on apoptosis of intestinal mucosal cells in rats with severe acute pancreatitis[J]. Eur Rev Med Pharmacol Sci, 2013, 17(11): 1529-1535.
15. 周濟宏, 李幼生, 洪志堅, 等. 腫瘤壞死因子對谷氨酰胺促大鼠小腸蛋白質合成的影響及途徑[J]. 醫學研究生學報, 2013, 26(12): 1244-1249.
16. 李明泉, 舒磊, 王曉霞, 等. 谷氨酰胺強化治療對危重癥病人臨床結局影響的系統性研究[J]. 腸外與腸內營養, 2014, 21(2): 101-105.
17. Cruzat VF, Bittencourt A, Scomazzon SP, et al. Oral free and dipeptide forms of glutamine supplementation attenuate oxidative stress and inflammation induced by endotoxemia[J]. Nutrition, 2014, 30(5): 602-611.
18. 胡秀英, 許春芳, 王超, 等. 含谷氨酰胺的腸外營養對急性胰腺炎患者預后影響的Meta分析[J]. 現代生物醫學進展, 2013, 13(22): 4302-430.

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West China Medical Journal

The Clinical Effects of Exogenous Glutamine on Sepsis Patients with Hypoalbuminemia

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