O'Leary Michael J, Koll Michael, Ferguson Colin N, Coakley John H, Hinds Charles J, Preedy Victor R, Garlick Peter J
Department of Intensive Care, The St George Hospital, Gray Street, Kogarah, NSW 2217, Australia.
Clin Sci (Lond). 2003 Dec;105(6):691-8. doi: 10.1042/CS20030128.
The effect of sepsis on liver synthesis of albumin remains controversial, with studies in man suggesting that synthesis increases, whereas in animals increased, decreased and unaltered synthesis have been reported. To reconcile these conflicting data, total and relative albumin synthesis was measured in rats 24 h after caecal ligation and puncture (CLP) by immunoprecipitation of albumin following a flooding dose of L-[4-3H]phenylalanine. Following CLP, animals were starved for 18 h and then received intravenous infusions of saline or parenteral nutrition (PN) with or without glutamine for 6 h. In animals receiving PN, parenteral injections of growth hormone (GH) or saline vehicle were also administered. Fractional rate of liver total protein synthesis was elevated and total albumin synthesis rate was reduced in all CLP groups when compared with non-operated animals. Total albumin synthesis was also lower in all animals receiving PN than those receiving saline alone, although these differences did not attain statistical significance, except for the group receiving PN+GH. Relative albumin synthesis was also reduced after CLP, and was significantly lower in animals receiving PN than in those receiving saline alone. These findings suggest that in sepsis hepatic protein synthesis is reprioritized away from the production of albumin towards the production of acute-phase proteins and that this change is not influenced by the provision of nutritional support, glutamine or the administration of GH.
脓毒症对肝脏白蛋白合成的影响仍存在争议，人体研究表明合成增加，而动物研究则报道合成增加、减少及未改变。为了协调这些相互矛盾的数据，在大鼠盲肠结扎和穿刺（CLP）24小时后，通过给予大剂量L-[4-³H]苯丙氨酸后免疫沉淀白蛋白来测定总白蛋白合成和相对白蛋白合成。CLP后，动物禁食18小时，然后接受静脉输注生理盐水或肠外营养（PN），添加或不添加谷氨酰胺，持续6小时。在接受PN的动物中，还给予了生长激素（GH）或生理盐水载体的肠胃外注射。与未手术动物相比，所有CLP组肝脏总蛋白合成的分数率升高，总白蛋白合成率降低。所有接受PN的动物的总白蛋白合成也低于仅接受生理盐水的动物，尽管这些差异除了接受PN+GH的组外未达到统计学意义。CLP后相对白蛋白合成也降低，接受PN的动物明显低于仅接受生理盐水的动物。这些发现表明，在脓毒症中，肝脏蛋白质合成从白蛋白的产生重新分配到急性期蛋白的产生，并且这种变化不受营养支持、谷氨酰胺或GH给药的影响。
