[The influence of alanyl-glutamine on immunologic functions and morbidity in postoperative total parenteral nutrition. Preliminary results of a prospective randomized trial].

Abstract

Glutamine seems to play an important role in metabolism and function of immunologic cells and therefore could also influence postoperative immunosuppression in surgical patients. Nevertheless, the influence of glutamine substitution in postoperative total parenteral nutrition on immunologic function and postoperative morbidity of patients is still unknown. Therefore, the impact of glutamine substitution on postoperative immunosuppression and incidence of complications was investigated in patients with surgical interventions on esophagus or stomach and total parenteral nutrition in a prospective randomized trial. To analyse the immunologic competence of the patients, the expression of CD-3, CD-4, and CD-8 on lymphocytes as well as the expression of HLA-DR and CD-14 on monocytes were evaluated before, 1, 2, 4, 7 days after surgery. Furthermore, plasma levels of IL-6 and IL-10 were analysed during the perioperative course. Actually, 34 patients have been included (with glutamine: n = 18 vs. without glutamine: n = 16) in the study. Patients with glutamine substitution showed non significantly decreased systemic inflammation (IL-6-plasma levels, leucocytosis) and significantly faster compensation of postoperative immunosuppression (HLA-DR-monocytes). Incidence of postoperative complications was decreased after glutamine substitution compared with the control group. Patients without postoperative complications showed no significant difference in postoperative immunosuppression. Although additional substitution of the amino acid glutamine might possibly decrease incidence of postoperative complications in patients with total parenteral nutrition a general advantage in postoperative immune function could not be demonstrated.