Suliman Mohammed E, Qureshi A Rashid, Stenvinkel Peter, Pecoits-Filho Roberto, Bárány Peter, Heimbürger Olof, Anderstam Björn, Rodríguez Ayala Ernesto, Divino Filho José C, Alvestrand Anders, Lindholm Bengt
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Am J Clin Nutr. 2005 Aug;82(2):342-9. doi: 10.1093/ajcn.82.2.342.
Inflammation and malnutrition are common in chronic kidney disease (CKD) patients, and plasma concentrations of free amino acids (AAs) in these patients are often abnormal. Malnutrition contributes to alterations in AA concentrations.
The objective was to study the effects of inflammation on plasma AA concentrations.
Concentrations of plasma AAs, serum albumin, and several inflammatory markers were analyzed in 200 fasting, nondiabetic CKD patients who were close to the start of renal replacement therapy. The nutritional status of these patients was assessed by a subjective global assessment.
The patients with inflammation [C-reactive protein (CRP) concentrations >10 mg/L] or malnutrition had lower AA concentrations than did the patients with no inflammation or malnutrition. The presence of both inflammation and malnutrition was associated with more marked reductions in AA concentrations than was malnutrition alone. Significant inverse correlations were observed between the plasma concentrations of most of the essential and nonessential AAs and inflammatory markers, whereas serum albumin concentrations were positively correlated with several AA concentrations. A stepwise multivariate regression analysis showed that serum CRP concentrations were independently associated with low concentrations of the sums of both nonessential AAs and all AAs. An analysis of all-cause mortality with a Kaplan-Meier test showed that the patients with higher AA concentrations had significantly better survival than did the patients with lower AA concentrations.
Plasma AA concentrations are low in CKD patients with inflammation and are inversely correlated with concentrations of inflammatory markers. Although inflammation and malnutrition are closely related, CRP concentrations were independently associated with low concentrations of the sums of both nonessential AAs and all AAs, which suggests an independent role of inflammation as a cause of low plasma AA concentrations in CKD patients.
炎症和营养不良在慢性肾脏病（CKD）患者中很常见，这些患者血浆中游离氨基酸（AA）的浓度常常异常。营养不良会导致氨基酸浓度改变。
研究炎症对血浆氨基酸浓度的影响。
分析了200例即将开始肾脏替代治疗的空腹、非糖尿病CKD患者的血浆氨基酸浓度、血清白蛋白浓度以及几种炎症标志物。通过主观全面评定法评估这些患者的营养状况。
有炎症（C反应蛋白（CRP）浓度>10mg/L）或营养不良的患者，其氨基酸浓度低于无炎症或营养不良的患者。同时存在炎症和营养不良的患者，其氨基酸浓度降低程度比单纯营养不良的患者更明显。观察到大多数必需氨基酸和非必需氨基酸的血浆浓度与炎症标志物之间存在显著负相关，而血清白蛋白浓度与几种氨基酸浓度呈正相关。逐步多元回归分析表明，血清CRP浓度与非必需氨基酸总和以及所有氨基酸总和的低浓度独立相关。采用Kaplan-Meier检验进行的全因死亡率分析显示，氨基酸浓度较高的患者生存率显著高于氨基酸浓度较低的患者。
有炎症的CKD患者血浆氨基酸浓度较低，且与炎症标志物浓度呈负相关。虽然炎症和营养不良密切相关，但CRP浓度与非必需氨基酸总和以及所有氨基酸总和的低浓度独立相关，这表明炎症在CKD患者血浆氨基酸浓度降低中具有独立作用。
