Progress in the application of glutamine in nutritional support after hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Xiaoyan ^1,2 , ZHANG Youdi ^1,2 ,  ZHOU Wence ²

1. School of Nursing of Lanzhou University, Lanzhou 730000, P. R. China;
2. The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding?author：

ZHOU Wence, Email: zhouwc@lzu.edu.cn

Keywords：

glutamine; hepatectomy; nutritional support; review

DOI：

10.7507/1007-9424.201811095

Video：

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Objective To summarize the current status of research in nutritional support for glutamine after hepatectomy.Method The literatures on nutritional support of glutamine after hepatectomy in recent years were reviewed by searching domestic and foreign literatures.Results The administration of glutamine up-regulated the expression of liver regeneration genes after partial hepatectomy in malnourished rats, and then stimulated cell mitosis by paracrine and endocrine cells, affecting the uptake of amino acids by hepatocytes and intestinal cells, and promoting hepatocyte proliferation. In clinical applications, glutamine could improve postoperative liver function and immune function, reduce the incidence of infectious complications, then relatively shorten the length of hospital stay, and improve the clinical outcome of patients.Conclusion Glutamine is beneficial to the recovery of liver function and has clinical application value.

Citation： LIU Xiaoyan, ZHANG Youdi, ZHOU Wence. Progress in the application of glutamine in nutritional support after hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(5): 631-635. doi: 10.7507/1007-9424.201811095 Copy

1.	相迪, 戴建國. 原發性肝癌的綜合治療研究進展. 山東醫藥, 2017, 57(20): 111-113.
2.	Tiernan JP, Liska D. Enhanced recovery after surgery: recent developments in colorectal surgery. Surg Clin North Am, 2018, 98(6): 1241-1249.
3.	王曉紅, 蒲娟, 楊智茹, 等. 快速康復外科聯合心理護理對髖關節置換患者身心健康及康復進程的影響. 中國健康心理學雜志, 2018, 26(11): 1702-1706.
4.	Ji F, Liang Y, Fu S, et al. Prognostic value of combined preoperative prognostic nutritional index and body mass index in HCC after hepatectomy. HPB (Oxford), 2017, 19(8): 695-705.
5.	Takagi K, Yagi T, Umeda Y, et al. Preoperative Controlling Nutritional Status (CONUT) score for assessment of prognosis following hepatectomy for hepatocellular carcinoma. World J Surg, 2017, 41(9): 2353-2360.
6.	劉升輝, 盧綺萍. 肝臟外科疾病圍手術期營養支持治療的研究進展. 中國普通外科雜志, 2015, 24(8): 1181-1186.
7.	Mullen JT, Davenport DL, Hutter MM, et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol, 2008, 15(8): 2164-2172.
8.	Holecek M. Nutritional modulation of liver regeneration by carbohydrates, lipids, and amino acids: a review. Nutrition, 1999, 15(10): 784-788.
9.	Birkhahn RH, Awad S, Thomford NR. Parenteral monoacetoacetin and liver regeneration interaction after partial hepatectomy in the rat. JPEN J Parenter Enteral Nutr, 1994, 18(3): 219-224.
10.	Ciuni R, Biondi A, Grosso G, et al. Nutritional aspects in patient undergoing liver resection. Updates Surg, 2011, 63(4): 249-252.
11.	Li L, Wang H, Yang J, et al. Geriatric nutritional risk index predicts prognosis after hepatectomy in elderly patients with hepatitis B virus-related hepatocellular carcinoma. Sci Rep, 2018, 8(1): 12561.
12.	Harimoto N, Yoshizumi T, Sakata K, et al. Prognostic Significance of Preoperative Controlling Nutritional Status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma. World J Surg, 2017, 41(11): 2805-2812.
13.	Okabayashi T, Iyoki M, Sugimoto T, et al. Oral supplementation with carbohydrate- and branched-chain amino acid-enriched nutrients improves postoperative quality of life in patients undergoing hepatic resection. Amino Acids, 2011, 40(4): 1213-1220.
14.	Bo Y, Yao M, Zhang L, et al. Preoperative Nutritional Risk Index to predict postoperative survival time in primary liver cancer patients. Asia Pac J Clin Nutr, 2015, 24(4): 591-597.
15.	Satoh S, Tanaka A, Hatano E, et al. Energy metabolism and regeneration in transgenic mouse liver expressing creatine kinase after major hepatectomy. Gastroenterology, 1996, 110(4): 1166-1174.
16.	Passos de Jesus R, De Nardi L, Da Rós N, et al. Amino acids change liver growth factors gene expression in malnourished rats. Nutr Hosp, 2010, 25(3): 382-387.
17.	滑麗美, 劉曉軍, 趙青蘭, 等. 添加谷氨酰胺營養治療對食管癌患者營養狀況影響的meta分析. 解放軍醫藥雜志, 2014, 26(6): 43-46, 53.
18.	楊屹立, 郭天康, 詹渭鵬, 等. 谷氨酰胺強化腸內營養對胃癌術后免疫功能影響的Meta分析. 現代腫瘤醫學, 2015, 23(5): 658-662.
19.	揭志剛, 李偉, 李正榮, 等. 丙氨酰谷氨酰胺對胃腸道腫瘤患者術后營養及免疫功能的影響. 中華普通外科學文獻( 電子版), 2010, 4(2): 128-131.
20.	丁佑銘, 付海峰, 周文波. 腸內免疫微生態營養支持對肝癌肝切除術后病人肝損害的影響. 腸外與腸內營養, 2014, 21(4): 214-216, 221.
21.	Takahashi N, Kumanaka H, Takagi H, et al. Stimulating effects of bovine small intestine mucosal factors on rat hepatocyte development. In Vitro Cell Dev Biol, 1989, 25(4): 365-372.
22.	Higashiguchi T, Hasselgren PO, Wagner K, et al. Effect of glutamine on protein synthesis in isolated intestinal epithelial cells. JPEN J Parenter Enteral Nutr, 1993, 17(4): 307-314.
23.	Higashiguchi T, Noguchi Y, Meyer T, et al. Protein synthesis in isolated enterocytes from septic or endotoxaemic rats: regulation by glutamine. Clin Sci (Lond), 1995, 89(3): 311-319.
24.	Wang XD, Andersson R, Soltesz V, et al. Bacterial translocation after major hepatectomy in patients and rats. Arch Surg, 1992, 127(9): 1101-1106.
25.	Wang XD, Soltesz V, Andersson R. Cisapride prevents enteric bacterial overgrowth and translocation by improvement of intestinal motility in rats with acute liver failure. Eur Surg Res, 1996, 28(6): 402-412.
26.	Wang XD, P?rsson H, Andersson R, et al. Bacterial translocation, intestinal ultrastructure and cell membrane permeability early after major liver resection in the rat. Br J Surg, 1994, 81(4): 579-584.
27.	Andrade ME, Araújo RS, de Barros PA, et al. The role of immunomodulators on intestinal barrier homeostasis in experimental models. Clin Nutr, 2015, 34(6): 1080-1087.
28.	Li Y, Chen Y, Zhang J, et al. Protective effect of glutamine-enriched early enteral nutrition on intestinal mucosal barrier injury after liver transplantation in rats. Am J Surg, 2010, 199(1): 35-42.
29.	Chaudhry KK, Shukla PK, Mir H, et al. Glutamine supplementation attenuates ethanol-induced disruption of apical junctional complexes in colonic epithelium and ameliorates gut barrier dysfunction and fatty liver in mice. J Nutr Biochem, 2016, 27: 16-26.
30.	Shu X, Zhang J, Wang Q, et al. Glutamine decreases intestinal mucosal injury in a rat model of intestinal ischemia-reperfusion by downregulating HMGB1 and inflammatory cytokine expression. Exp Ther Med, 2016, 12(3): 1367-1372.
31.	Jiang Q, Chen J, Liu S, et al. l-Glutamine attenuates apoptosis induced by endoplasmic reticulum stress by activating the IRE1α-XBP1 axis in IPEC-J2: a novel mechanism of l-Glutamine in promoting intestinal health. Int J Mol Sci, 2017, 18(12): 1-14.
32.	Magalh?es CR, Malafaia O, Torres OJ, et al. Liver regeneration with l-glutamine supplemented diet: experimental study in rats. Rev Col Bras Cir, 2014, 41(2): 117-121.
33.	Passos de Jesus Mazza R, Bertevello PL, Matos de Miranda Torrinhas R, et al. Effect of glutamine dipeptide on hepatic regeneration in partially hepatectomized malnourished rats. Nutrition, 2003, 19(11-12): 930-935.
34.	Ito A, Higashiguchi T. Effects of glutamine administration on liver regeneration following hepatectomy. Nutrition, 1999, 15(1): 23-28.
35.	安軍, 付維利, 丁潔. L-谷氨酰胺與肝臟大部分切除后的再生. 中國組織工程研究與臨床康復, 2011, 15(31): 5827-5830.
36.	Yoshida S, Yunoki T, Aoyagi K, et al. Effect of glutamine supplement and hepatectomy on DNA and protein synthesis in the remnant liver. J Surg Res, 1995, 59(4): 475-481.
37.	陳惟. 谷氨酰胺免疫營養支持對有營養風險肝膽手術病人圍手術期肝功能與免疫功能的影響. 廣州: 南方醫科大學, 2017.
38.	奇鐵男, 孫丹. 谷氨酰胺聯合異甘草酸鎂治療重癥急性胰腺炎的臨床效果. 中國衛生標準管理, 2018, 9(20): 74-76.
39.	Sempoux C, Bisig B, Couchy G, et al. Malignant transformation of a β-catenin inflammatory adenoma due to an S45β-catenin-activating mutation present 12 years before. Hum Pathol, 2017, 62: 122-125.
40.	Osada T, Nagashima I, Tsuno NH, et al. Prognostic significance of glutamine synthetase expression in unifocal advanced hepatocellular carcinoma. J Hepatol, 2000, 33(2): 247-253.
41.	Helling G, Wahlin S, Smedberg M, et al. Plasma glutamine concentrations in liver failure. PLoS One, 2016, 11(3): e0150440.
42.	田銀生, 李毅, 周濤. 強化谷氨酰胺的腸外營養支持在肝癌肝切除術后的臨床研究. 成都醫學院學報, 2012, 7(2): 190-191.
43.	伍崗泉, 車瀟, 鄒國杰. 口服谷氨酰胺對肝部分切除患者術后的影響. 中華普通外科學文獻(電子版), 2011, 5(3): 214-217.

1. 相迪, 戴建國. 原發性肝癌的綜合治療研究進展. 山東醫藥, 2017, 57(20): 111-113.
2. Tiernan JP, Liska D. Enhanced recovery after surgery: recent developments in colorectal surgery. Surg Clin North Am, 2018, 98(6): 1241-1249.
3. 王曉紅, 蒲娟, 楊智茹, 等. 快速康復外科聯合心理護理對髖關節置換患者身心健康及康復進程的影響. 中國健康心理學雜志, 2018, 26(11): 1702-1706.
4. Ji F, Liang Y, Fu S, et al. Prognostic value of combined preoperative prognostic nutritional index and body mass index in HCC after hepatectomy. HPB (Oxford), 2017, 19(8): 695-705.
5. Takagi K, Yagi T, Umeda Y, et al. Preoperative Controlling Nutritional Status (CONUT) score for assessment of prognosis following hepatectomy for hepatocellular carcinoma. World J Surg, 2017, 41(9): 2353-2360.
6. 劉升輝, 盧綺萍. 肝臟外科疾病圍手術期營養支持治療的研究進展. 中國普通外科雜志, 2015, 24(8): 1181-1186.
7. Mullen JT, Davenport DL, Hutter MM, et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol, 2008, 15(8): 2164-2172.
8. Holecek M. Nutritional modulation of liver regeneration by carbohydrates, lipids, and amino acids: a review. Nutrition, 1999, 15(10): 784-788.
9. Birkhahn RH, Awad S, Thomford NR. Parenteral monoacetoacetin and liver regeneration interaction after partial hepatectomy in the rat. JPEN J Parenter Enteral Nutr, 1994, 18(3): 219-224.
10. Ciuni R, Biondi A, Grosso G, et al. Nutritional aspects in patient undergoing liver resection. Updates Surg, 2011, 63(4): 249-252.
11. Li L, Wang H, Yang J, et al. Geriatric nutritional risk index predicts prognosis after hepatectomy in elderly patients with hepatitis B virus-related hepatocellular carcinoma. Sci Rep, 2018, 8(1): 12561.
12. Harimoto N, Yoshizumi T, Sakata K, et al. Prognostic Significance of Preoperative Controlling Nutritional Status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma. World J Surg, 2017, 41(11): 2805-2812.
13. Okabayashi T, Iyoki M, Sugimoto T, et al. Oral supplementation with carbohydrate- and branched-chain amino acid-enriched nutrients improves postoperative quality of life in patients undergoing hepatic resection. Amino Acids, 2011, 40(4): 1213-1220.
14. Bo Y, Yao M, Zhang L, et al. Preoperative Nutritional Risk Index to predict postoperative survival time in primary liver cancer patients. Asia Pac J Clin Nutr, 2015, 24(4): 591-597.
15. Satoh S, Tanaka A, Hatano E, et al. Energy metabolism and regeneration in transgenic mouse liver expressing creatine kinase after major hepatectomy. Gastroenterology, 1996, 110(4): 1166-1174.
16. Passos de Jesus R, De Nardi L, Da Rós N, et al. Amino acids change liver growth factors gene expression in malnourished rats. Nutr Hosp, 2010, 25(3): 382-387.
17. 滑麗美, 劉曉軍, 趙青蘭, 等. 添加谷氨酰胺營養治療對食管癌患者營養狀況影響的meta分析. 解放軍醫藥雜志, 2014, 26(6): 43-46, 53.
18. 楊屹立, 郭天康, 詹渭鵬, 等. 谷氨酰胺強化腸內營養對胃癌術后免疫功能影響的Meta分析. 現代腫瘤醫學, 2015, 23(5): 658-662.
19. 揭志剛, 李偉, 李正榮, 等. 丙氨酰谷氨酰胺對胃腸道腫瘤患者術后營養及免疫功能的影響. 中華普通外科學文獻( 電子版), 2010, 4(2): 128-131.
20. 丁佑銘, 付海峰, 周文波. 腸內免疫微生態營養支持對肝癌肝切除術后病人肝損害的影響. 腸外與腸內營養, 2014, 21(4): 214-216, 221.
21. Takahashi N, Kumanaka H, Takagi H, et al. Stimulating effects of bovine small intestine mucosal factors on rat hepatocyte development. In Vitro Cell Dev Biol, 1989, 25(4): 365-372.
22. Higashiguchi T, Hasselgren PO, Wagner K, et al. Effect of glutamine on protein synthesis in isolated intestinal epithelial cells. JPEN J Parenter Enteral Nutr, 1993, 17(4): 307-314.
23. Higashiguchi T, Noguchi Y, Meyer T, et al. Protein synthesis in isolated enterocytes from septic or endotoxaemic rats: regulation by glutamine. Clin Sci (Lond), 1995, 89(3): 311-319.
24. Wang XD, Andersson R, Soltesz V, et al. Bacterial translocation after major hepatectomy in patients and rats. Arch Surg, 1992, 127(9): 1101-1106.
25. Wang XD, Soltesz V, Andersson R. Cisapride prevents enteric bacterial overgrowth and translocation by improvement of intestinal motility in rats with acute liver failure. Eur Surg Res, 1996, 28(6): 402-412.
26. Wang XD, P?rsson H, Andersson R, et al. Bacterial translocation, intestinal ultrastructure and cell membrane permeability early after major liver resection in the rat. Br J Surg, 1994, 81(4): 579-584.
27. Andrade ME, Araújo RS, de Barros PA, et al. The role of immunomodulators on intestinal barrier homeostasis in experimental models. Clin Nutr, 2015, 34(6): 1080-1087.
28. Li Y, Chen Y, Zhang J, et al. Protective effect of glutamine-enriched early enteral nutrition on intestinal mucosal barrier injury after liver transplantation in rats. Am J Surg, 2010, 199(1): 35-42.
29. Chaudhry KK, Shukla PK, Mir H, et al. Glutamine supplementation attenuates ethanol-induced disruption of apical junctional complexes in colonic epithelium and ameliorates gut barrier dysfunction and fatty liver in mice. J Nutr Biochem, 2016, 27: 16-26.
30. Shu X, Zhang J, Wang Q, et al. Glutamine decreases intestinal mucosal injury in a rat model of intestinal ischemia-reperfusion by downregulating HMGB1 and inflammatory cytokine expression. Exp Ther Med, 2016, 12(3): 1367-1372.
31. Jiang Q, Chen J, Liu S, et al. l-Glutamine attenuates apoptosis induced by endoplasmic reticulum stress by activating the IRE1α-XBP1 axis in IPEC-J2: a novel mechanism of l-Glutamine in promoting intestinal health. Int J Mol Sci, 2017, 18(12): 1-14.
32. Magalh?es CR, Malafaia O, Torres OJ, et al. Liver regeneration with l-glutamine supplemented diet: experimental study in rats. Rev Col Bras Cir, 2014, 41(2): 117-121.
33. Passos de Jesus Mazza R, Bertevello PL, Matos de Miranda Torrinhas R, et al. Effect of glutamine dipeptide on hepatic regeneration in partially hepatectomized malnourished rats. Nutrition, 2003, 19(11-12): 930-935.
34. Ito A, Higashiguchi T. Effects of glutamine administration on liver regeneration following hepatectomy. Nutrition, 1999, 15(1): 23-28.
35. 安軍, 付維利, 丁潔. L-谷氨酰胺與肝臟大部分切除后的再生. 中國組織工程研究與臨床康復, 2011, 15(31): 5827-5830.
36. Yoshida S, Yunoki T, Aoyagi K, et al. Effect of glutamine supplement and hepatectomy on DNA and protein synthesis in the remnant liver. J Surg Res, 1995, 59(4): 475-481.
37. 陳惟. 谷氨酰胺免疫營養支持對有營養風險肝膽手術病人圍手術期肝功能與免疫功能的影響. 廣州: 南方醫科大學, 2017.
38. 奇鐵男, 孫丹. 谷氨酰胺聯合異甘草酸鎂治療重癥急性胰腺炎的臨床效果. 中國衛生標準管理, 2018, 9(20): 74-76.
39. Sempoux C, Bisig B, Couchy G, et al. Malignant transformation of a β-catenin inflammatory adenoma due to an S45β-catenin-activating mutation present 12 years before. Hum Pathol, 2017, 62: 122-125.
40. Osada T, Nagashima I, Tsuno NH, et al. Prognostic significance of glutamine synthetase expression in unifocal advanced hepatocellular carcinoma. J Hepatol, 2000, 33(2): 247-253.
41. Helling G, Wahlin S, Smedberg M, et al. Plasma glutamine concentrations in liver failure. PLoS One, 2016, 11(3): e0150440.
42. 田銀生, 李毅, 周濤. 強化谷氨酰胺的腸外營養支持在肝癌肝切除術后的臨床研究. 成都醫學院學報, 2012, 7(2): 190-191.
43. 伍崗泉, 車瀟, 鄒國杰. 口服谷氨酰胺對肝部分切除患者術后的影響. 中華普通外科學文獻(電子版), 2011, 5(3): 214-217.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress in the application of glutamine in nutritional support after hepatectomy

Abstract Full text Figures/Tables Video References Cited by

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