Objective: To explore the effect of total parenteral nutrition (TPN) supplemented with glutamine on the activity of plasma diamine oxidase (DAO) and D-lactate content in blood of patients with multiple organ dysfunction syndrome (MODS).
Methods: Forty patients with MODS in the intensive care unit (ICU) from September 2003 to June 2005 were involved in a randomized controlled study, and divided into routine group (group A, n=20), the glutamine +TPN treatment group (group B, n=20). All patients received equivalent nitrogen and caloric values in parenteral nutrition. Group A was given routine TPN, and group B was given extra glutamine 0.27 g.kg(-1).d(-1) (i. e. dipeptiven 0.4 g.kg(-1).d(-1)) for 7 days. The activity of plasma DAO and D-lactate content, the treatment time and the mortality rate of the two groups were determined before TPN, on the 1st, the 3rd and the 7th day after TPN. At the same time, 20 healthy blood donors formed the healthy control group (group C). All the data were analyzed with the SPSS 10.0 software.
Results: Before treatment, the activity of plasma DAO and D-lactate content of the two patient groups were significantly higher than those of group C (both P<0.01), and there was no difference between group A and group B (P>0.05). After the treatment of glutamine supplemented TPN, the activity of plasma DAO and D-lactate content of group B were lower than those of group A (both P<0.01). The duration of TPN was (15.8+/-2.3) days for group A and (12.5+/-2.4) days for group B. The former was significantly longer than that of group B (P<0.05). The mortality rate of group A was 25%, the mortality rate of group B was 10%, but there was no significant difference between the two groups (P>0.05).
Conclusion: The glutamine (dipeptiven) supplementation through vein can help increase the supply of energy substrate to intestinal mucosa epithelium, and decrease the activity of plasma DAO and D-lactate content. It has an important effect on protecting the intestinal mucosa epithelial function. It also helps shorten the TPN treatment course.