Our aim was to compare the effects of intravenous, enteral, and enteral plus intravenous supplemented glutamine on plasma transferrin, nitrogen balance, and creatinine/height index in septic patients with malnutrition. Blood and urine samples were collected for transferrin, urea and creatinine measurements. Samples, SOFA score and protein-calorie intake values were repeated on days 7 and 15. Patients (n:120) were randomly divided into 4 groups. Group I received 30 g/day IV glutamine, group II received 30 g/day enteral glutamine, group III received 15 g/day IV and 15 g/day enteral glutamine. Group IV received only enteral feeding as a control group. Transferrin levels decreased in group IV (p<0.01 0-7 days, p<0.01 7-15 days, p<0.01 0-15 days). Nitrogen balance levels were highest in group IV when compared with group I (p<0.05, p<0.001), group II (p<0.001), and group III (p<0.05, p<0.001) on days 7-15. Creatinine/height indexes increased in group I (p<0.001), group II (p<0.001), group III (p<0.001), and group IV (p<0.05) on day 15. In group III the creatinine/height index was higher than in groups I and II (p<0.05). In group IV, creatinine/height index was lower than in group I (p<0.01) and group II (p<0.001). Protein-calorie intake in group IV was higher than others on day 7 (p<0.05). SOFA scores of group IV were higher than the other groups on day 15 (p<0.05). This study demonstrated, that combined route of gln supplementation resulted in the most positive outcome to transferrin, creatine/height index and nitrogen balance (on days 7 and 15) during the catabolic phase of septic patients with malnutrition.
本研究目的為比較以不同途徑補充麩醯胺酸，分別為靜脈輸入、腸道攝取、及 靜脈輸入合併腸道攝取三種方式，對於營養不良之敗血症病患，其血漿運鐵蛋 白、氮平衡與肌酸酐/身高指數之效果。收集血液和尿液樣本，用於測量運鐵蛋 白、尿素和肌酸酐。在試驗第7 及15 天重複收集生化樣本、執行器官衰竭評 分(SOFA score)與記錄蛋白質熱量攝取量。將120 位病患隨機分配到四組。第 一組每日以靜脈營養方式補充30 g 麩醯胺酸；第二組每日由腸道攝取30 g 麩 醯胺酸；第三組每日以靜脈輸入15 g 麩醯胺酸，再加上腸道攝取15 g 麩醯胺 酸；第四組為控制組，以腸道營養進食。運鐵蛋白數量在第四組顯著減少(0-7 天 p<0.01；7-15 天 p<0.01；0-15 天 p<0.01)。氮平衡在第7 及15 天，與第一組 (p<0.05, p<0.001)、第二組(p<0.001)、第三組(p<0.05, p<0.001)比較，第四組為 最高。肌酸酐/身高指數在第15 天各組均有顯著提升。第三組肌酸酐/身高指數 比第一組及第二組高；第四組則比第一組及第二組低。蛋白質熱量攝取量在第 7 天，第四組較其他組別高(p<0.05)。器官衰竭分數在第15 天，第四組較其他 組高(p<0.05)。本研究顯示，結合腸道與靜脈營養的途徑補充麩醯胺酸，對於 營養不良之敗血症病患，其運鐵蛋白、肌酸酐/身高指數與氮平衡有最正面的效 果(在第7 與15 天)。