Objective: The aim of study was to confirm the protective effects of parenteral glutamine supplementation on liver injury in premature infants and determine how quickly effects became evident.
Methods: We performed a double-blind, randomized, controlled clinical study to assess the effect of parenteral nutrition (PN) supplemented with glutamine in premature infants. Thirty infants from two children's centers, were randomly assigned to either a control group (Standard PN; n=15) or a glutamine-supplemented group (GlnPN; n=15). The primary endpoint was hepatic function. The secondary endpoints were total duration of PN, weight and head circumference gain, length of hospitalization, and days on a ventilator.
Results: The serum level of alkaline phosphatase (AKP) after parenteral nutrition for 14 days was significantly higher (p<0.05) in the control group. But in the glutamine-supplemented group, the serum concentration of aspartate aminotransferase (AST) and gamma glutamyltransferase (GGT) significantly decreased after PN for 7 days and 14 days (p<0.05), and the level of alkaline phosphatase (AKP) showed no increase. The levels of AKP and GGT were significantly different with time by group interaction. Levels of AKP was higher in control group than glutamine-supplemented group, and GGT level was lower in glutamine-supplemented group compared with controls. There were no significant differences between the groups in terms of total duration of PN, weight gain (g/d), increase in head circumference (cm/w), length of hospitalization, and duration of mechanical ventilation.
Conclusion: The longer the duration of parenteral nutrition, the more severe hepatic dysfunction became. Parenteral glutamine supplementation suggested a hepatoprotective effect.
目的: 本研究目的是证实补充谷氨酰胺肠外营养(PN)对早产儿肝脏功能的保护作 用。方法:采用双盲、随机、对照试验，评价补充谷氨酰胺肠外营养对早产儿的 作用。来自两家儿童医疗中心的30例早产儿随机分为对照组(标准PN；n=15)和 谷氨酰胺组(GlnPN；n=15)。首要终点指标为肝功能。次要终点指标为PN持续 时间，体重和头围增长情况，住院天数和呼吸机应用天数。结果：肠外营养应 用14天后，血清碱性磷酸酶(alkaline phosphatase, AKP)水平在对照组明显升高 (p<0.05)。在谷氨酰胺组，谷草转氨酶(aspartate aminotransferase, AST)水平和γ- 谷氨酰转肽酶(gamma glutamyltransferase, GGT)水平在肠外营养应用7天和14天 后明显下降(p<0.05)，AKP水平无明显升高。AKP水平和GGT水平在两组比较 具有统计学差异。AKP水平在对照组较谷氨酰胺组明显升高，GGT水平在谷氨 酰胺组下降较对照组明显。肠外营养应用时间、体重和头围增长情况、住院天 数和呼吸机应用天数， 两组比较无差异。结论: 肠外营养持续时间越长，肝功 能损害越严重，而肠外补充谷氨酰胺具有保护肝脏功能的作用。