谷氨酰胺在早产儿坏死性小肠结肠炎预防性应用中的研究进展

doi:10.11852/zgetbjzz2020-0213

摘要/Abstract

摘要： 坏死性小肠结肠炎(NEC)是早产儿最常见的急性和致死性消化道急症之一,其主要表现为腹胀、便血等,严重者可出现肠穿孔甚至败血症。目前,NEC的病因及发病机制尚未明确,有研究发现肠黏膜屏障损害可能与其发病有关,谷氨酰胺(Gln)作为人体所需的条件必需氨基酸,在维持肠黏膜完整性,减少肠黏膜受损、缺血坏死中具有不可替代的作用,本文就谷氨酰胺在早产儿坏死性小肠结肠炎的预防性应用作一综述。

关键词: 谷氨酰胺, 坏死性小肠结肠炎, 早产儿

Abstract: Necrotizing enterocolitis (NEC) is one of the most common acute and fatal gastrointestinal emergencies in premature infants,mainly manifested as abdominal distension,hematochetia,etc.In severe cases,intestinal perforation and even septicemia may occur.The etiology and pathogenesis is unclear,some studies have found that intestinal mucosa barrier damage may be related to its pathogenesis,glutamine (Gln),the essential amino acid for human body,plays an irreplaceable role in maintaining intestinal mucosal integrity and reducing intestinal mucosal damage and ischemic necrosis.This paper reviews the preventive application of glutamine in NEC in premature infants.

Key words: glutamine, necrotizing enterocolitis, premature infants

中图分类号:

R722.6

张海建, 朱明哲. 谷氨酰胺在早产儿坏死性小肠结肠炎预防性应用中的研究进展[J]. 中国儿童保健杂志, 2021, 29(3): 285-288.

ZHANG Hai-jian, ZHU Ming-zhe. Research progress on the preventive application of glutamine in necrotizing enterocolitis in premature infants[J]. journal1, 2021, 29(3): 285-288.

参考文献

[1] Neu J.Necrotizing enterocolitis[J].World Rev Nutr Diet,2014,110:253-263.
[2] Hays S,Jacquot A,Gauthier H,et al.Probiotics and growth in preterm infants:A randomized controlled trial,PREMAPRO study[J].Clin Nutr,2016,35(4):802-811.
[3] Lin HY,Chang JH,Chung MY,et al.Prevention of necrotizingenterocolitis in preterm very low birth weight infants:is it feasible?[J].J Formos Med Assoc,2014,113(8):490-497.
[4] Briassouli E,Briassoulis G.Glutamine randomized studies in early life:the unsolved riddle of experimental and clinical studies[J].Clin Dev Immunol,2012,2012:749189.
[5] Zhang X,Jiang X.Effects of enteral nutrition on the barrier function of the intestinal mucosa and dopamine receptor expression in rats with traumatic brain injury[J].JPEN JParenter Enteral Nutr,2015,39(1):114-123.
[6] Cruzat V,Rogero MM,Keane KN,et al.Glutamine:Metabolism and immune function,supplementation and clinical translation[J].Nutrients,2018,10(11):1564.
[7] Turner JR.Intestinal mucosal barrier function in health and disease[J].Nat RevImmunol,2009,9(11):799-809.
[8] Beutheu S,Ghouzali I,Galas L,et al.Glutamine and arginine improve permeability and tight junction protein expression in methotrexate-treated Caco-2 cells[J].Clin Nutr,2013,32(5):863-869.
[9] Ewaschuk JB,Murdoch GK,Johnson IR,et al.Glutamine supplementation improves intestinal barrier function in a weaned piglet model of Escherichia coli infection[J].Br J Nutr,2011,106(6):870-877.
[10] El-Shimi MS,Awad HA,Abdelwahed MA,et al.Enteral L-arginine and glutamine supplem- entation for prevention of NEC in preterm neonates[J].Int J Pediatr,2015,2015:856091.
[11] Swaid F,Sukhotnik I,Matter I,et al.Dietary glutamine supplementation prevents mucosal injury and modulates intestinal epithelial restitution following acetic acid induced intestinal injury in rats[J].Nutr Metab (Lond),2013,10:53.
[12] Moe-Byrne T,Brown JV,McGuire W.Glutamine supplementation to prevent morbidity and mortality in preterm infants[J].Cochrane Database Syst Rev,2016,4(4):CD001457.
[13] Holecek M.Side effects of long-term glutamine supplementation[J].JPEN J Parenter Enteral Nutr,2013,37(5):607-616.
[14] Sánchez B,Delgado S,Blanco-Míguez A,et al.Probiotics,gut microbiota,and their influence on host health and disease[J].Mol Nutr Food Res,2017,61(1):10.1002.
[15] Mai V,Torrazza RM,Ukhanova M,et al.Distortions in development of intestinal microbiota associated with late onset sepsis in preterm infants[J].PLoS one,2013,8(1):e52876.
[16] Yazji I,Sodhi CP,Lee EK,et al.Endothelial TLR4 activation impairs intestinal microcirculatory perfusion in necrotizing enterocolitis via eNOS-NO-nitrite signaling[J].Proc Natl Acad Sci USA,2013,110(23):9451-9456.
[17] Gong ZY,Yuan ZQ,Dong ZW,et al.Glutamine with probiotics attenuates intestinal inflammation and oxidative stress in a rat burn injury model through alterediNOS gene aberrant methylation[J].Am J Transl Res,2017,9(5):2535-2547.
[18] Mihi B,Good M.Impact of toll-like receptor 4 signaling in necrotizing enterocolitis:the state of the science[J].Clin Perinatol,2019,46(1):145-157.
[19] Larson SD,Li J,Chung DH,et al.Molecular mechanisms contributing to glutamine-mediated intestinal cell survival[J].Am JPhysiol Gastrointest Liver Physiol,2007,293(6):G1262-G1271.
[20] Zhou W,Li W,Zheng XH,et al.Glutamine downregulates TLR-2 and TLR-4 expression and protects intestinal tract in preterm neonatal rats with necrotizing enterocolitis[J].J Pediatr Surg,2014,49(7):1057-1063.
[21] Qiu JL,Song BL,Wang YJ,et al.Role of glutamine in the mediation of E-cadherin,p120-catenin and inflammation in ventilator-induced lung injury[J].Chin Med J (Engl),2018,131(7):804-812.
[22] Shouval DS,Ouahed J,Biswas A,et al.Interleukin 10 receptor signaling:master regulator of intestinal mucosal homeostasis in mice and humans[J].Adv Immunol,2014,122:177-210.
[23] Abreu MT.The Ying and Yang of bacterial signaling in necrotizingenterocolitis[J].Gastroenterology,2010,138(1):39-43.
[24] Niño DF,Sodhi CP,Hackam DJ.Necrotizing enterocolitis:new insights into pathogenesis and mechanisms[J].Nat Rev Gastroenterol Hepatol,2016,13(10):590-600.
[25] Jeon JI,Ko SH,Kim JM,et al.Intestinal epithelial cells exposed to bacteroides fragilis enterotoxin regulate nf-κb activation and inflammatory responses through β-catenin expression[J].Infect Immun,2019,87(11):e00312-19.
[26] Ruth MR,Field CJ.The immune modifying effects of amino acids on gut-associated lymphoid tissue[J].JAnim Sci Biotechnol,2013,4(1):27.
[27] Nakaya M,Xiao Y,Zhou X,et al.Inflammatory T cell responses rely on amino acid transporter ASCT2 facilitation of glutamine uptake and mTORC1 kinase activation[J].Immunity,2014,40(5):692-705.
[28] Ren W,Yin J,Wu M,et al.Serum amino acids profile and the beneficial effects of L-arginine or L-glutamine supplementation in dextran sulfate sodium colitis[J].PLoS One,2014,9(2):e88335.
[29] Nair J,Gugino SF,Nielsen LC,et al.Fetal and postnatal ovine mesenteric vascular reactivity[J].Pediatr Res,2016,79(4):575-582.
[30] Perger L,Mukhopadhyay D,Komidar L,et al.Maternal pre-eclampsia as a risk factor for necrotizing enterocolitis[J].J Matern Fetal Neonatal Med,2016,29(13):2098-2103.
[31] BOOST II United Kingdom Collaborative Group,BOOST II Australia Collaborative Group,BOOST II New Zealand Collaborative Group,et al.Oxygen saturation and outcomes in preterm infants[J].NEngl J Med,2013,368(22):2094-2104.
[32] Bowker RM,Yan X,Managlia E,et al.Dimethyloxalylglycine preserves the intestinal microvasculature and protects against intestinal injury in a neonatal mouse NEC model:role of VEGF signaling[J].Pediatr Res,2018,83(2):545-553.
[33] Yan X,Managlia E,Liu SX,et al.Lack of VEGFR2 signaling causes maldevelopment of the intestinal microvasculature and facilitates necrotizing enterocolitis in neonatal mice[J].Am J Physiol Gastrointest Liver Physiol,2016,310(9):G716-G725.
[34] Premkumar MH,Sule G,Nagamani SC,et al.Argininosuccinate lyase in enterocytes protects from development of necrotizing enterocolitis[J].Am J Physiol Gastrointest Liver Physiol,2014,307(3):G347-G354.
[35] Gong ZY,Yuan ZQ,Dong ZW,et al.Glutamine with probiotics attenuates intestinal inflammation and oxidative stress in a rat burn injury model through alterediNOS gene aberrant methylation[J].Am J Transl Res,2017,9(5):2535-2547.
[36] 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[J].Exp Ther Med,2016,12(3):1367-1372.
[37] Pai MH,Shih YM,Shih JM,et al.Glutamine modulates changes in intestinal intraepithelial γδt-lymphocyte expressions in mice with ischemia/reperfusion injury[J].Shock,2015,44(1):77-82.