Veeneman Jorden M, Kingma Hermi A, Boer Theo S, Stellaard Frans, De Jong Paul E, Reijngoud Dirk-Jan, Huisman Roel M
Division of Nephrology, Department of Internal Medicine, University Hospital Groningen and Groningen University Institute of Drug Exploration, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Am J Physiol Endocrinol Metab. 2003 May;284(5):E954-65. doi: 10.1152/ajpendo.00264.2002. Epub 2003 Jan 21.
Protein energy malnutrition is present in 18 to 56% of hemodialysis patients. Because hemodialysis has been regarded as a catabolic event, we studied whether consumption of a protein- and energy-enriched meal improves the whole body protein balance during dialysis in chronic hemodialysis (CHD) patients. Patients were studied on a single day between dialysis (HD- protocol) in the morning while fasting and in the afternoon while consuming six small test meals. Patients were also studied during two separate dialysis sessions (HD+ protocol). Patients were fasted during one and consumed the meals during the other. Whole body protein metabolism was studied by primed constant infusion of l-[1-(13)C]valine. During HD-, feeding changed the negative whole body protein balance observed during fasting to a positive protein balance. Dialysis deepened the negative balance during fasting, whereas feeding during dialysis induced a positive balance comparable to the HD- protocol while feeding. Plasma valine concentrations during the studies were correlated with whole body protein synthesis and inversely correlated with whole body protein breakdown. We conclude that the consumption of a protein- and energy-enriched meal by CHD patients while dialyzing can strongly improve whole body protein balance, probably because of the increased amino acid concentrations in blood.
18%至56%的血液透析患者存在蛋白质能量营养不良。由于血液透析被视为一种分解代谢事件，我们研究了食用富含蛋白质和能量的餐食是否能改善慢性血液透析（CHD）患者透析期间的全身蛋白质平衡。在上午透析（HD方案）期间空腹以及下午食用六份小份测试餐时，对患者进行了单日研究。还在两个单独的透析疗程（HD+方案）中对患者进行了研究。在其中一个疗程中患者禁食，在另一个疗程中食用餐食。通过一次性持续输注l-[1-(13)C]缬氨酸来研究全身蛋白质代谢。在HD-期间，进食将禁食期间观察到的全身负蛋白质平衡转变为正蛋白质平衡。透析加深了禁食期间的负平衡，而透析期间进食诱导的正平衡与HD-方案进食时相当。研究期间的血浆缬氨酸浓度与全身蛋白质合成相关，与全身蛋白质分解呈负相关。我们得出结论，CHD患者在透析时食用富含蛋白质和能量的餐食可显著改善全身蛋白质平衡，这可能是由于血液中氨基酸浓度增加所致。
