(3.236.222.124) 您好!臺灣時間:2021/05/19 11:19
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

: 
twitterline
研究生:曾旭弘
論文名稱:二肽谷酰胺(麩胺醯胺)在全靜脈營養之下對肝硬化患者氧化壓力之作用
論文名稱(外文):The effect of dipeptide glutamine on the oxidative stress of liver cirrhotic patient under total parenteral nutrition
指導教授:陳伯中陳伯中引用關係
學位類別:碩士
校院名稱:弘光科技大學
系所名稱:營養醫學研究所
學門:醫藥衛生學門
學類:營養學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:73
中文關鍵詞:麩胺醯胺肝硬化氧化壓力
相關次數:
  • 被引用被引用:0
  • 點閱點閱:439
  • 評分評分:
  • 下載下載:75
  • 收藏至我的研究室書目清單書目收藏:0
背景 :

麩胺醯胺 (Glutamine) 是人體重要的胺基酸, 肝臟會擷取然後進行各項轉換及作用。 透過不同分子機制完成許多生理調節功能。在臨床上, 合併使用全靜脈營養於重症患者以改善病況已獲得治療上之佐證。 全靜脈營養易伴隨產生肝臟病變,會引起肝硬化進一步的肝功能受損。 在B 型肝炎盛行的亞洲及台灣, 肝硬化的肝功能受損是值得注意而不可忽視的。 對肝硬化病人, 口服麩胺醯胺已知會引發高氮素血症。 肝硬化病人需要接受全靜脈營養時, 是否可以同時使用麩胺醯胺以減少肝功能障礙, 是值得探討的。

目的 :

動物實驗上, 麩胺醯胺經由影響氧化壓力有保護肝臟的效果。 對肝硬化病人之氧化壓力效應則未明。 經由測定血漿中生化檢驗數據及氧化壓力狀況, 來評估麩胺醯胺對肝硬化病人在使用全靜脈營狀況下否有加成作用或造成不利影響。 是本實驗的重要目的。

方法 :

選擇20-90歲使用全靜脈營養肝硬化成年病人, 排除急性腎衰竭, 急性肝衰竭, 對所用藥物過敏者。 病人或家屬簽署受試者自願書。 共22人 其中4人在研究中因本身疾病死亡而退出。 患者分實驗組(glutamine group)12人與控制組(control group)6人。 實驗組注麩胺醯胺注射液7天。 在給麩胺醯胺前, 及第8天抽血, 測定血中生化值及抗氧化劑濃度並作分析。

結果 :

以實驗組與對照組比較, 基礎抽血值無明顯差異; 第8天抽血值中, 氧化還原指數(rodex index, GSH/GSSG)及超氧陰離子(O2- )有明顯差異。 以前後抽血值比較, 實驗組中, 過氧化氫(H2O2)及鹼性磷酸酶(Alkaline phosphatase)之增加有顯著差異; 對照組則無。 血液氨於兩組間或麩胺醯胺使用前後並無明顯增加。 麩胺醯胺劑量對過氧化氫(H2O2)有顯著負相關(r=-0.584); 對氧化還原指數(GSH/GSSG)有顯著正相關(r=0.611)。 實驗組病人較多中等程度之肝硬化(Child B), 會影響病人整體狀況。 麩胺醯胺之需求劑量也因此要做調整。

結論 :

對中等程度之肝硬化病人於全靜脈營養中注射麩胺醯胺不會增加血液氨濃度。 靜脈注射麩胺醯胺劑量對增加氧化還原指數及減少過氧化氫有明顯相關。
Glutamine is an important amino acid in humans, which
undergoes multiple turn over processes in the liver. It is not only the source of amino acid, by way of molecular mechanism, but also adjusts biological functions. For critically-ill patients, nutrition supported by
total parenteral nutrition is frequent, but this may induce liver function abnormality originating from the complication of total parenteral nutrition. Glutamine is known to have benefits in anti-oxidative stress.
But glutamine itself as a donor of nitrogen will induce hyperammonia.In the areas of high prevalence of viral hepatitis, liver cirrhosis is common due to its chronic and subclinical presentation. The oxidative effect for parenteral glutamine in liver cirrhosis is not clear. The study evaluates the antioxidative components and biochemical data to illustrate the effect of glutamine in oxidative stress
22 patients were enrolled for study, 4 people died and hence was withdrawn from the study. Among the remaining, 12 were given glutamine (Dipeptiven®) 20g/100ml for 7 days, and grouped as glutamine. 6 patients were divided into control group. Blood samples were taken before and at the 8th day of glutamine administration.
Serum biochemistry and oxidative parameters were checked. The result was calculated by statistic analysis.
There was no significant difference in baseline data comparing glutamine group and control group, while rodex index (GSH/GSSG) and superoxide (O2-) had significant difference in 8th day value. In comparing baseline and 8th day value, there were no significant difference in control group, but hydrogen superoxide (H2O2) and Alkaline phosphatase (Alk-P) had significant difference in glutamine
group. No significant difference in serum ammonia was seen whether in comparing two groups or in comparing the baseline and 8th day value. Glutamine dosage has a significant negative correlation to hydrogen superoxide (H2O2) (r=-0.584) and a significant positive
correlation to rodex index (GSH/GSSG) (r=0.611). Glutamine group had more Child-Pugh classification B while control group had more Child-Pugh classification A. The difference interferes with the whole condition of patients. The dosage of glutamine should be adjusted to meet the clinical requirement.
In conclusion, no significant elevation of serum ammonia is seen in parenteral glutamine administration combined with total parenteral nutrition in moderate liver cirrhotic patient. Parenteral glutamine in cirrhotic patient has a significant correlation to an increase in rodex index and decrease in hydrogen peroxide level.
中文摘要…........................................................ 1
ABSTRACT……………………………………………………………………………………………………………………. 3
縮寫表….............................................................................................……….…….................................................................... 5
REAGENT LIST……………………………………………………………………………………………………………….. 6
CHAPTER 1 BACKGROUND.………………..………………...............................................……………………………… 8
CHAPTER 2 LITERATURE REVIEW………………………………………………………..……………………….......… 10
2.1 Glutamine....................................................................................................................................................................... 10
2.1.1 Property................................................................................................................................................................ 10
2.1.2 Conditionally essential amino acid.................................................................................. ................................... 15
2.1.3 Non-nutritive role...................... ........... .............................................................................................................. 15
2.1.4 Preparation of glutamine...................................................................................................................................... 17
2.1.5 Route of administration....................................................................................................................................... 18
2.1.6 Clinical usage and effect...................................................................................................................................... 19
2.2 Total parenteral nutrition................................................................................................................................................. 20
2.2.1 Purpose and indication........................................................................................................................................ 20
2.2.2 Complication........................................................................................................................................................ 21
2.2.3 Oxidative stress.................................................................................................................................................... 22
2.3 Liver cirrhosis.................................................................................................................................................................. 23
2.3.1 Incidence and prevalence..................................................................................................................................... 23
2.3.2 Clinical presentation............................................................................................................................................ 24
2.3.3 Oxidative stress.................................................................................................................................................... 26
2.4 Relationship.between.glutamine,.parenteral.nutrition.&.cirrhosis.................................................................................. 27
2.5 Free radical and rodex cycle............................................................................................................................................ 29
CHAPTER 3 MATERIALS AND METHODS......................................................................................................................... 32
3.1 Patient characteristics....................................................................................................................................................... 32
3.2 Methods............................................................................................................................................................................ 33
3.2.1 Clinical laboratory analysis.................................................................................................................................. 34
3.2.2 Oxidative and antioxidant parameter analysis..................................................................................................... 35
3.3 Statistical analysis............................................................................................................................................................ 45
CHAPTER 4 RESULTS................................................................................................................................................... 46
4.1 Patient characteristics....................................................................................................................................................... 46
4.2 Significant difference between two groups...................................................................................................................... 48
4.2.1 Biochemistry parameters...................................................................................................................................... 48
4.2.2 Oxidative stress parameters.................................................................................................................................. 51
4.3 Significant difference of parameters between baseline and post-treatment 8th day........................................................ 55
4.3.1 Biochemistry parameter................................................................................................................................. 55
4.3.2 Oxidative stress parameter................................................................................................................................... 58
4.4 The difference in oxidative stress between glutamine and control group........................................................................ 62
4.5 Correlation....................................................................................................................................................................... 65
CHAPTER 5 DISCUSSION.......................................................................................................................................... 67
CHAPTER 6 CONCLUSION........................................................................................................................................ 72
Reference...................................................................................................................................................................................... 73
Biolo G, Zorat F, Antonione R and Ciocchi B. Muscle glutamine depletion in the intensive care unit. Int J Biochem Cell Biol. (2005) 37: 2169-79


Brosnan JT. Interorgan amino acid transport and its regulation. J Nutr (2003) 133: 2068S–2072S

Bongers T, Griffiths RD and McArdle A. Exogenous glutamine: The clinical evidence. Crit Care Med (2007) 35:S545-52

Novak F, Heyland DK, Avenell A, Drover JW and Su X. Glutamine supplementation in serious illness : A systematic review of the evidence. Crit Care Med (2002) Vol. 30, No. 9

Wischmeyer PE. Glutamine: role in critical illness and ongoing clinical trials. Curr Opin Gastroenterol (2008) 24:190-7

Buchman A. Total parenteral nutrition-associated liver disease. JPEN J Parenter Enteral Nutr (2002)26:S43-8

Stumvoll M, Perriello G, Meyer C and Gerich J. Role of glutamine in human carbohydrate metabolism in kidney and other tissues. Kidney Int (1999) Vol. 55 pp 778–792

Brosnan JT. Interorgan amino acid transport and its regulation. J Nutr (2003) 133:2068S-2072S

Masini A, Efrati C, Merli M, Nicolao F, Amodio P, Del Piccolo F and Riggio O. Effect of Blood Ammonia Elevation following Oral Glutamine Load on the Psychometric Performance of Cirrhotic Patients. Metab Brain Dis (2003)18:27-35

Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN, Hasnian SS, Leung N, Lesmana L, Phiet PH, Sjalfoellah Noer HM, Sollano J, Sun HS and Xu DZ. Chronic hepatitis B virus infection in Asian countries. J Gastroenterol Hepatol (2000) 15:1356-61

Chu CM . Natural history of chronic hepatitis B virus infection in adults with emphasis on the occurrence of cirrhosis and hepatocellular carcinoma. J Gastroenterol Hepatol. (2000)15 :E25-30

Yuen MF and Lai CL. Natural history of chronic hepatitis B virus infection. J Gastroenterol Hepatol (2000)15 :E20-4

Wu J, Hong L, Cai W, Tang Q and Shi C. Glutamine attenuates TPN-associated liver injury in infant rabbits. Eur J Pediatr (2007) 166:601-6

Jia CJ, Dai CL, Zhang X, Cui K, Xu F, Xu YQ. Alanyl-glutamine dipeptide inhibits hepatic ischemiareperfusion injury in rats. World J Gastroenterol (2006) 12:1373-1378

Lu J, Wang XY and Tang WH. Glutamine attenuates nitric oxide synthase expression and mitochondria membrane potential decrease in interleukin-1beta-activated rat hepatocytes. Eur J Nutr (2009) 06

Melis GC, ter Wengel N, Boelens PG and van Leeuwen PA. Glutamine: recent developments in research on the clinical significance of glutamine. Curr Opin Clin Nutr Metab Care (2004) 7(1):59-70

Biolo G, Zorat F, Antonione R and Ciocchi B. Muscle glutamine depletion in the intensive care unit. Int J Biochem Cell Biol (2005) 37:2169-79

Young VR and Ajami AM. Glutamine: The Emperor or His Clothes? J Nutr (2001)131:2449S-59S

Tapiero H, Mathé G, Couvreur P and Tew KD. II. Glutamine and glutamate. Biomed Pharmacother (2002) 56:446-57

Newsholme P, Lima MM, Procopio J, Pithon-Curi TC, Doi SQ, Bazotte RB and Curi R. Glutamine and glutamate as vital metabolites. Braz J Med Biol Res. (2003) 36(2):153-63

Buchman AL. Glutamine: commercially essential or conditionally essential? A critical appraisal of the human data. Am J Clin Nutr. (2001) 74:25-32

Lacey JM and Wilmore DW. Is glutamine a conditionally essential amino acid. Nutr Rev (1990) 48:297-309

Parry-Billings M, Baigrie RJ, Lamont PM, Morris PJ and Newsholme EA. Effects of major and minor surgery on plasma glutamine and cytokine levels. Arch Surg (1992)127:1237-40

Blomqvist BI, Hammarqvist F, von der Decken A and Wernerman J. Glutamine and alpha-ketoglutarate prevent the decrease in muscle free glutamine concentration and influence protein synthesis after total hip replacement. Metabolism (1995) 44:1215-22

Planas M and Schwartz S, Arbos MA and Farriol M. Plasma glutamine levels in septic patients. JPEN J Parenter Enteral Nutr (1993) 17:299-300

Oehler R, Pusch E, Dungel P, Zellner M, Eliasen MM, Brabec M and Roth E. Glutamine depletion impairs cellular stress response in human leucocytes. Br J Nutr (2002) 87 :S17-21

Roth E, Funovics J, Mühlbacher F, Schemper M, Mauritz W, Sporn P and Fritsch A. Metabolic disorders in severe abdominal sepsis: glutamine deficiency in skeletal muscle. Clin Nutr (1982) 1:25-41

Shao A and Hathcock JN. Risk assessment for the amino acids taurine, L-glutamine and L-arginine. Regul Toxicol Pharmacol (2008) 50: 376-99

Gamrin L, Essén P, Forsberg AM, Hultman E and Wernerman J. A descriptive study of skeletal muscle metabolism in critically ill patients: Free amino acids, energy-rich phosphates, protein, nucleic acids, fat, water, and electrolytes. Crit Care Med (1996) 24:575-83

Karinch AM, Pan M, Lin CM, Strange R and Souba WW. Glutamine metabolism in sepsis and infection. J Nutr (2001) 131 :2535S–2538S

Parry-Billings M, Evans J, Calder PC and Newsholme EA. Does glutamine contribute to immunosuppression after major burns? Lancet (1990) 336(8714):523-5

Planas M, Schwartz S, Arbós MA and Farriol M. Plasma glutamine levels in septic patients. JPEN J Parenter Enteral Nutr. (1993) 17:299-300

Wilmore DW and Shabert JK. Role of Glutamine in Immunologic Responses. Nutrition (1998) 14:618-26

Curi R, Lagranha CJ, Doi SQ, Sellitti DF, Procopio J, Pithon-Curi TC, Corless M and Newsholme P. Molecular Mechanisms of Glutamine Action. J Cell Physiol (2005) 204 :392-401

Wischmeyer PE . The glutamine story: where are we now? Curr Opin Crit Care (2006) 12 :142-8

Forman HJ, Zhang H and Rinna A. Glutathione: Overview of its protective roles, measurement, and biosynthesis. Mol Aspects Med (2009) 30 :1-12

Anderson ME. Glutathione: an overview of biosynthesis and modulation. Chem Biol Interact. (1998) 24;111-112:1-14

Yagasaki M and Hashimoto S. Synthesis and application of dipeptides; current status and perspectives. Appl Microbiol Biotechnol (2008) 81 :13-22

Fürst P. Old and New Substrates in Clinical Nutrition. J Nutr (1998) 128 :789-96

Fürst P, Pogan K, and Stehle P. Glutamine Dipeptides in Clinical Nutrition (1997) 13:731-7

Garrel D, Patenaude J, Nedelec B, Samson L, Dorais J, Champoux J, D'Elia M and Bernier J. Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: A prospective, controlled, randomized clinical trial. Crit Care Med (2003) 31 : 2444-9

Zhou YP, Jiang ZM, Sun YH, Wang XR, Ma EL and Wilmore D. The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns: a randomized, double-blind, controlled clinical trial. JPEN J Parenter Enteral Nutr (2003) 27 :241-5

Heyland DK, Dhaliwal R, Day AG, Muscedere J, Drover J, Suchner U, Cook D and Canadian Critical Care Trials Group. REducing Deaths due to OXidative Stress (The REDOXSg Study): rationale and study design for a randomized trial of glutamine and antioxidant supplementation in critically-ill patients. Proc Nutr Soc (2006) 65 :250-63

Haisch M, Fukagawa NK and Matthews DE. Oxidation of glutamine by the splanchnic bed in humans. Am J Physiol Endocrinol Metab (2000) 278 :E593-602

Boelens PG, Melis GC, van Leeuwen PA, ten Have GA and Deutz NE. Route of administration (enteral or parenteral) affects the contribution of L-glutamine to de novo L-arginine synthesis in mice: a stable-isotope study. Am J Physiol Endocrinol Metab (2006) 291:E683-90

Boelens PG, van Leeuwen PA, Dejong CH, Deutz NE. Intestinal renal metabolism of L-citrulline and L-arginine following enteral or parenteral infusion of L-alanyl-L-[2,15N]glutamine or L-[2,15N]glutamine in mice. Am J Physiol Gastrointest Liver Physiol (2005) 289(4):G679-85

Melis GC, Boelens PG, van der Sijp JR, Popovici T, De Bandt JP, Cynober L and van Leeuwen PA. The feeding route (enteral or parenteral) affects the plasma response of the dipetide Ala-Gln and the amino acids glutamine, citrulline and arginine, with the administration of Ala-Gln in preoperative patients. Br J Nutr (2005) 94(1):19-26

Ligthart-Melis GC, van de Poll MC, Dejong CH, Boelens PG, Deutz NE and van Leeuwen PA. The route of administration (enteral or parenteral) affects the conversion of isotopically labeled L-(2-15N) glutamine into citrulline and arginine in humans. JPEN J Parenter Enteral Nutr (2007) 31 :343-48

Luo M, Bazargan N, Griffith DP, Estívariz CF, Leader LM, Easley KA, Daignault NM, Hao L, Meddings JB, Galloway JR, Blumberg JB, Jones DP and Ziegler TR. Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: a pilot study. Clin Nutr (2008) 27:297-306

Novak F, Heyland DK, Avenell A, Drover JW and Su X. Glutamine supplementation in serious illness : A systematic review of the evidence. Crit Care Med (2002) 30 :2022-9

Lin MT, Kung SP, Yeh SL, Lin C, Lin TH, Chen KH, Liaw KY, Lee PH, Chang KJ and Chen WJ. The effect of glutamine-supplemented total parenteral nutrition on nitrogen economy depends on severity of diseases in surgical patients. Clin Nutr (2002) 21 :213-8

Wernerman J. Role of glutamine supplementation in critically ill patients. Curr Opin Anaesthesiol. (2008) 21:155-9

Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R and Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. (2004) 20 :843-8

Jeejeebhoy KN. Total parenteral nutrition: potion or poison. Am J Clin Nutr (2001) 74 (2):160-3

Heyland DK, MacDonald S, Keefe L and Drover JW. Total Parenteral Nutrition in the Critically Ill Patient A Meta-analysis. JAMA (1998) 16;280(23):2013-9

Knochel JP. Complications of total parenteral nutrition. Kidney Int (1985) 27 :489-96

Montalvo-Jave EE, Zarraga JL and Sarr MG. Specific topics and complications of parenteral nutrition. Langenbecks Arch Surg (2007) 392:119-26

Guglielmi FW, Boggio-Bertinet D, Federico A, Forte GB, Guglielmi A, Loguercio C, Mazzuoli S, Merli M, Palmo A, Panella C, Pironi L and Francavilla A. Total parenteral nutrition-related gastroenterological complications. Dig Liver Dis (2006) 38:623-42.

LumanW and Shaffer JL. Prevalence, outcome and associated factors of deranged liver function tests in patients on home parenteral nutrition. Clin Nutr (2002) 21(4):337-43

Kwan V and George J. Liver disease due to parenteral and enteral nutrition. Clin Liver Dis (2004) 8(4):893-913, ix-x

Kumpf VJ. Parenteral Nutrition-Associated Liver Disease in Adult and Pediatric Patients. Nutr Clin Pract (2006) 21(3):279-90

Raman M and Allard JP. Parenteral nutrition related hepato-biliary disease in adults. Appl Physiol Nutr Metab (2007) 32(4):646-54

Cai W, Wu J, Hong L, Xu Y, Tang Q and Shi C. Oxidative injury and hepatocyte apoptosis in total parenteral nutrition-associated liver dysfunction. J Pediatr Surg. (2006) 41 :1663-8

Wang H, Khaoustov VI, Krishnan B, Cai W, Stoll B, Burrin DG and Yoffe B. Total Parenteral Nutrition Induces Liver Steatosis and Apoptosis in Neonatal Piglets. J Nutr (2006) 136 :2547-52

Hong L, Wu J and Cai W. Glutathione Decreased Parenteral Nutrition-Induced Hepatocyte Injury in Infant Rabbits. JPEN J Parenter Enteral Nutr (2007) 31:199-204

Mager DR, Marcon M, Wales P and Pencharz PB. Use of N-Acetyl Cysteine for the Treatment of Parenteral Nutrition–induced Liver Disease in Children Receiving Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr (2008) 46 :220-3

Schuppan D and Afdhal NH. Afdhal. Liver Cirrhosis. Lancet (2008) 8;371(9615):838-51

Mathews RE Jr, McGuire BM and Estrada CA. Outpatient Management of Cirrhosis: A Narrative Review. South Med J (2006) 99(6):600-6

Chang MH, Chen CJ, Lai MS, Hsu HM, Wu TC, Kong MS, Liang DC, Shau WY and Chen DS. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med (1997) 26;336(26):1855-9

Chien YC, Jan CF, Kuo HS and Chen CJ. Nationwide hepatitis B vaccination program in Taiwan: effectiveness in the 20 years after it was launched. Epidemiol Rev (2006) 28:126-35

Chen CC, Yen CH, Wu WY, Hu SW, Chen SC, Bell WR and Lee MC. Epidemiology of hepatitis B virus infection among young adults in Taiwan, China after public vaccination program. Chin Med J (Engl) (2007) 120:1155-8

Heidelbaugh JJ and Bruderly M. Cirrhosis and chronic liver failure: Part I. diagnosis and evaluation. Am Fam Physician (2006) 74(5):756-62

Heidelbaugh JJ and Sherbondy M. Cirrhosis and chronic liver failure: Part II. complications and treatment. Am Fam Physician (2006) 74(5):767-76

Olde Damink SW, Jalan R and Dejong CH. Interorgan ammonia trafficking in liver disease. Metab Brain Dis (2009) 24(1):169-81

Pastor A, Collado PS, Almar M and González-Gallego J. Microsomal function in biliary obstructed rats: effects of S-adenosylmethionine. J Hepatol. (1996) 24 :353-9

Natarajan SK, Thomas S, Ramamoorthy P, Basivireddy J, Pulimood AB, Ramachandran A and Balasubramanian KA. Oxidative stress in the development of liver cirrhosis: a comparison of two different experimental models. J Gastroenterol Hepatol (2006) 21 :947-57

Yamamoto Y, Yamashita S, Fujisawa A, Kokura S and Yoshikawa T. Oxidative Stress in Patients with Hepatitis, Cirrhosis,and Hepatoma Evaluated by Plasma Antioxidants. Biochem Biophys Res Commun. (1998) 247(1):166-70

Szuster-Ciesielska A, Daniluk J and Kandefer-Szerszeń M. Oxidative stress in the blood of patients with alcohol-related liver cirrhosis. Med Sci Monit (2002) 8(6):CR419-24

Venturini D, Simão AN, Barbosa DS, Lavado EL, Narciso VE, Dichi I and Dichi JB. Increased Oxidative Stress, Decreased Total Antioxidant Capacity, and Iron Overload in Untreated Patients with Chronic Hepatitis C. Dig Dis Sci. (2009) Jun 10

Bhandari S, Agarwal MP, Dwivedi S and Banerjee BD. Monitoring oxidative stress across worsening child pugh class of cirrhosis. Indian J Med Sci (2008) 62 :444-51

Masini A, Efrati C, Merli M, Nicolao F, Amodio P, Del Piccolo F and Riggio O. Effect of Blood Ammonia Elevation following Oral Glutamine Load on the Psychometric Performance of Cirrhotic Patients. Metab Brain Dis (2003) 18(1):27-35

Fan YP, Yu JC, Kang WM and Zhang Q. Effects of Glutamine Supplementation on Patients Undergoing Abdominal Surgery. Chin Med Sci J (2009) 24(1):55-9

Berivan TANDOĞAN and N. Nuray ULUSU. Kinetic Mechanism and Molecular Properties of Glutathione Reductase. FABAD J Pharm Sci (2006) 31(4): 230-237,

Roušar T, Pařík P, Kučera O, Bartoš M and Cervinková Z. Glutathione Reductase Is Inhibited by Acetaminophen-glutathione Conjugate in vitro. Physiol Res (2009 Jun) 19

Bakalar B, Duska F, Pachl J, Fric M, Otahal M, Pazout J and Andel M. Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients. Crit Care Med. (2006) 34 :381-6

Wernerman J. Suggestion for present and future use of parenteral glutamine. Clinical Nutrition Supplements (2004) 1: 37–42
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top