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Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2005; 11(39): 6197-6201
Published online Oct 21, 2005. doi: 10.3748/wjg.v11.i39.6197
Glutamine-supplemented total parenteral nutrition attenuates plasma interleukin-6 in surgical patients with lower disease severity
Ming-Tsan Lin, Sung-Pao Kung, Sung-Ling Yeh, Koung-Yi Liaw, Ming-Yang Wang, Ming-Liang Kuo, Po-Houng Lee, Wei-Jao Chen
Ming-Tsan Lin, Department of Surgery and Primary Care Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, China
Sung-Pao Kung, Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, China
Sung-Ling Yeh, Institute of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan, China
Koung-Yi Liaw, Ming-Yang Wang, Po-Houng Lee, Wei-Jao Chen, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, China
Ming-Liang Kuo, Laboratory of Molecular and Cellular Toxicology, Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan, China
Author contributions: All authors contributed equally to the work.
Supported by a Research Grant from the National Science Council, Taipei, Taiwan, No. NSC91-2314-B002-245
Correspondence to: Wei-Jao Chen, MD, PhD, Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan S. Road, Taipei, Taiwan, China.chenwj@ha.mc.ntu.edu.tw
Telephone: +886-2-23123456-2122 Fax: +886-2-23412969
Received: February 15, 2005
Revised: June 6, 2005
Accepted: June 9, 2005
Published online: October 21, 2005
Abstract

AIM: To evaluate whether the effect of Gln dipeptide-enriched total parenteral nutrition (TPN) on postoperative cytokine alteration depended on the disease severity of surgical patients.

METHODS: Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228 g nitrogen/kg per d) and isocaloric (30 kcal/kg per d) TPN for 6 d. Control group (Conv) using conventional TPN solution received 1.5 g amino acids/kg per day, whereas the test group received 0.972 g amino acids/kg per day and 0.417 g L-alanyl-L-glutamine (Ala-Gln)/kg per day. Blood samples were collected on d 1 and d 6 postoperatively for plasma interleukin (IL)-2, IL-6, IL-8, and interferon (IFN)-g analysis.

RESULTS: Plasma IL-2 and IFN-g were not detectable. IL-6 concentrations were significantly lower on the 6th postoperative day in the Ala-Gln group than those in the Conv group in patients with APACHE II≤6, whereas no difference was noted in patients with APACHE II>6. There was no difference in IL-8 levels between the two groups. No difference in cumulative nitrogen balance was observed on d 2-5 after the operation between the two groups (Ala-Gln -3.2±1.6 g vs Conv -6.5±2.7 g). A significant inverse correlation was noted between plasma IL-6 levels and cumulative nitrogen balance postoperatively in the Ala-Gln group, whereas no such correlation was observed in the Conv group.

CONCLUSION: TPN supplemented with Gln dipeptide had no effect on plasma IL-8 levels after surgery. However, Gln supplementation had a beneficial effect on decreasing systemic IL-6 production after surgery in patients with low admission illness severity, and lower plasma IL-6 may improve nitrogen balance in patients with abdominal surgery when Gln was administered.

Keywords: Glutamine, Total parenteral nutrition, Interleukin-6, Abdominal surgery