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, 戴建国. 原发性肝癌的综合治疗研究进展. 山东医药, 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.	王晓红, 蒲娟, 杨智茹, 等. 快速康复外科联合心理护理对髋关节置换患者身心健康及康复进程的影响. 中国健康心理学杂志, 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.	刘升辉, 卢绮萍. 肝脏外科疾病围手术期营养支持治疗的研究进展. 中国普通外科杂志, 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.	滑丽美, 刘晓军, 赵青兰, 等. 添加谷氨酰胺营养治疗对食管癌患者营养状况影响的meta分析. 解放军医药杂志, 2014, 26(6): 43-46, 53.
18.	杨屹立, 郭天康, 詹渭鹏, 等. 谷氨酰胺强化肠内营养对胃癌术后免疫功能影响的Meta分析. 现代肿瘤医学, 2015, 23(5): 658-662.
19.	揭志刚, 李伟, 李正荣, 等. 丙氨酰谷氨酰胺对胃肠道肿瘤患者术后营养及免疫功能的影响. 中华普通外科学文献( 电子版), 2010, 4(2): 128-131.
20.	丁佑铭, 付海峰, 周文波. 肠内免疫微生态营养支持对肝癌肝切除术后病人肝损害的影响. 肠外与肠内营养, 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, Pärsson 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.	Magalhães 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.	安军, 付维利, 丁洁. L-谷氨酰胺与肝脏大部分切除后的再生. 中国组织工程研究与临床康复, 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.	陈惟. 谷氨酰胺免疫营养支持对有营养风险肝胆手术病人围手术期肝功能与免疫功能的影响. 广州: 南方医科大学, 2017.
38.	奇铁男, 孙丹. 谷氨酰胺联合异甘草酸镁治疗重症急性胰腺炎的临床效果. 中国卫生标准管理, 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.	田银生, 李毅, 周涛. 强化谷氨酰胺的肠外营养支持在肝癌肝切除术后的临床研究. 成都医学院学报, 2012, 7(2): 190-191.
43.	伍岗泉, 车潇, 邹国杰. 口服谷氨酰胺对肝部分切除患者术后的影响. 中华普通外科学文献(电子版), 2011, 5(3): 214-217.

1. 相迪, 戴建国. 原发性肝癌的综合治疗研究进展. 山东医药, 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. 王晓红, 蒲娟, 杨智茹, 等. 快速康复外科联合心理护理对髋关节置换患者身心健康及康复进程的影响. 中国健康心理学杂志, 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. 刘升辉, 卢绮萍. 肝脏外科疾病围手术期营养支持治疗的研究进展. 中国普通外科杂志, 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. 滑丽美, 刘晓军, 赵青兰, 等. 添加谷氨酰胺营养治疗对食管癌患者营养状况影响的meta分析. 解放军医药杂志, 2014, 26(6): 43-46, 53.
18. 杨屹立, 郭天康, 詹渭鹏, 等. 谷氨酰胺强化肠内营养对胃癌术后免疫功能影响的Meta分析. 现代肿瘤医学, 2015, 23(5): 658-662.
19. 揭志刚, 李伟, 李正荣, 等. 丙氨酰谷氨酰胺对胃肠道肿瘤患者术后营养及免疫功能的影响. 中华普通外科学文献( 电子版), 2010, 4(2): 128-131.
20. 丁佑铭, 付海峰, 周文波. 肠内免疫微生态营养支持对肝癌肝切除术后病人肝损害的影响. 肠外与肠内营养, 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, Pärsson 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. Magalhães 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. 安军, 付维利, 丁洁. L-谷氨酰胺与肝脏大部分切除后的再生. 中国组织工程研究与临床康复, 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. 陈惟. 谷氨酰胺免疫营养支持对有营养风险肝胆手术病人围手术期肝功能与免疫功能的影响. 广州: 南方医科大学, 2017.
38. 奇铁男, 孙丹. 谷氨酰胺联合异甘草酸镁治疗重症急性胰腺炎的临床效果. 中国卫生标准管理, 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. 田银生, 李毅, 周涛. 强化谷氨酰胺的肠外营养支持在肝癌肝切除术后的临床研究. 成都医学院学报, 2012, 7(2): 190-191.
43. 伍岗泉, 车潇, 邹国杰. 口服谷氨酰胺对肝部分切除患者术后的影响. 中华普通外科学文献(电子版), 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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