重度慢性乙型病毒性肝炎患者肠黏膜通透性的变化及其机制

Effects of glutamine on intestinal permeability, endotoxemia and liver function in severe chronic hepatitis B patients

AIM: To study the effect of glutamine on intestinal permeability, endotoxemia and liver function in severe chronic hepatitis B patients.

METHODS: Sixty cases with severe chronic hepatitis B were randomly divided into two groups, the control group and the experimental group, with 30 cases in each group. For control group, the patients were given regular treatment, including hepatic protectants and anti-virology therapy. For experimental group, the patients were given extra glutamine 10 g tid in addition to regular treatment. The whole treatment duration lasted two weeks. Before and after treatment, patients in each group all undertook liver function test (ALT, AST, TBIL, PT, ALB, CHE) respectively. Meanwhile, the serum endotoxin (ET) level was measured by limulus lysate test, and the change of intestinal permeability by urine lactulos/mannitol ratio (L/M) were detected by high performance liquid chromatography with evaporative light scattering detector (HPLC-ELSD).

RESULTS: After 2 weeks' treatment, the total tests of liver function, serum endotoxin level, L/M showed positive changes in both of the experimental and control groups (P < 0.05 or 0.01). Compared with the control group, the positive changes of ALT, TBIL, CHE, ET, L/M between pre-treatment and post-treatment in treatment group had significant difference (281.86 ± 149.34 U vs 199.65 ± 127.09 U, 168.65 ± 102.04 µmol/L vs 94.13 ± 172.67 µmol/L, -1301.04 ± 662.78 U vs -892.23 ± 861.41 U, 0.0198 ± 0.0128 vs 0.0089 ± 0.0228, all P < 0.05).

CONCLUSION: Adding glutamine to regular treatment can reverse the intestinal permeability, ameliorate the endotoxemia, promoting the curling process of liver cells. For patients with severe chronic hepatitis B, it is very important to find and reverse the intestinal permeability in time in clinical practice.