Vehe K L, Brown R O, Moore L W, Acchiardo S R, Luther R W
Department of Pharmacy Nutrition Support, University of Tennessee, Memphis.
Pharmacotherapy. 1991;11(4):303-7.
Patients with chronic renal failure are at considerable nutritional risk due to restricted diets, poor intake, and dialysis-related protein losses; therefore, they often require specialized nutrition support. It is difficult, however, to gauge the success of the intervention, since the gold standard nitrogen balance cannot be easily employed. We examined the usefulness of three visceral proteins, insulinlike growth factor 1 (IGF-1), fibronectin (FBN), and prealbumin (PA), as markers of nutrition support efficacy in patients with chronic renal failure. Fourteen patients receiving enteral (1) or parenteral (13) nutrition were studied for 7-28 days. The six males and eight females attained intakes of protein and nonprotein energy of 1.3 +/- 0.3 (mean +/- SD) g/kg/day and 34 +/- 6 kcal/kg/day, respectively. Blood samples taken on days 1, 4, 7, 14, 21, and 28 were assayed for IGF-1, FBN, and PA concentrations. Protein levels were correlated with cumulative nonprotein energy and protein intake. Concentrations of IGF-1 at baseline (0.90 +/- 0.48 U/ml) rose significantly by day 4 (1.35 +/- 0.78 U/ml) and remained significantly above baseline at days 7 (1.44 +/- 0.68 U/ml), 14 (1.63 +/- 1.05 U/ml), and 28 (1.59 +/- 0.98 U/ml). Baseline FBN (113 +/- 53 micrograms/ml) and PA (15.3 +/- 7.8 mg/dl) concentrations rose significantly by day 28 (FBN, 163 +/- 51 micrograms/ml; PA, 24.6 +/- 19.0 mg/dl). The PA concentrations correlated significantly with cumulative nonprotein calories and cumulative protein intake (r = 0.37, p less than 0.01; r = 0.43, p less than 0.01, respectively). Both IGF-1 and PA show promise as markers of nutrition support efficacy in this complex patient population.
慢性肾衰竭患者由于饮食受限、摄入量低以及与透析相关的蛋白质丢失，面临着相当大的营养风险；因此，他们通常需要专门的营养支持。然而，由于难以轻易采用金标准氮平衡来评估干预的效果，所以很难判断干预是否成功。我们研究了三种内脏蛋白，即胰岛素样生长因子1（IGF-1）、纤连蛋白（FBN）和前白蛋白（PA）作为慢性肾衰竭患者营养支持疗效标志物的有效性。对14例接受肠内营养（1例）或肠外营养（13例）的患者进行了7至28天的研究。6名男性和8名女性的蛋白质摄入量和非蛋白质能量摄入量分别为1.3±0.3（平均±标准差）克/千克/天和34±6千卡/千克/天。在第1、4、7、14、21和28天采集血样，检测IGF-1、FBN和PA的浓度。蛋白质水平与累积非蛋白质能量和蛋白质摄入量相关。基线时IGF-1的浓度为（0.90±0.48 U/ml），到第4天显著升高至（1.35±0.78 U/ml），并在第7天（1.44±0.68 U/ml）、第14天（1.63±1.05 U/ml）和第28天（1.59±0.98 U/ml）仍显著高于基线水平。基线时FBN（113±53微克/毫升）和PA（15.3±7.8毫克/分升）的浓度在第28天显著升高（FBN为163±5I微克/毫升；PA为24.6±19.0毫克/分升）。PA浓度与累积非蛋白质热量和累积蛋白质摄入量显著相关（r分别为0.37，p<0.0 I；r为0.43，p<0.01）。在这个复杂的患者群体中，IGF-1和PA都有望作为营养支持疗效的标志物。
